Original article
Asthma, lower airway disease
Evaluating quality of life in patients with asthma and rhinitis: English adaptation of the rhinasthma questionnaire

https://doi.org/10.1016/j.anai.2010.10.027Get rights and content

Background

Separate health-related quality of life (HRQL) instruments exist for asthma and rhinitis. The Rhinasthma questionnaire, originally developed in Italian, is a unique measure designed for use where both conditions coexist.

Objective

We sought to assess the performance and validity of a new adaptation of the Rhinasthma questionnaire for use in English-speaking populations.

Methods

We analyzed cross-sectional data from an ongoing study of adults with asthma and rhinitis (n = 450), asthma alone (n = 75), or rhinitis alone (n = 20). Subjects were administered an English translation of the original 30-item Rhinasthma questionnaire. Health status measures simultaneously assessed include the Short Form (SF)-12, EuroQol (EQ)-5D, and Marks Asthma Quality-of-Life.

Results

Variable cluster analysis of the original 30-item instrument identified 5 discrete item clusters corresponding to the following domains: nasal (5 items), eye (4 items), respiratory (5 items), activity restriction (9 items), and treatment burden (5 items). Two other items were removed because of poor item-cluster correlations. Subjects with concomitant asthma and rhinitis had greater HRQL impairment, as measured by the Rhinasthma, than subjects with either asthma or rhinitis alone. The Rhinasthma correlated significantly (P < .05) with the SF-12, EQ-5D, and Marks Asthma Quality-of-Life in the anticipated direction consistent with the underlying constructs. In multiple logistic regression, poorer Rhinasthma HRQL was associated with significantly (P < .05) increased odds of both asthma- and rhinitis-related disability even after taking into account physical health status as measured by the SF-12.

Conclusion

The 28-item English adaptation of Rhinasthma performs well in assessing HRQL in patients with asthma, rhinitis, or both conditions combined.

Introduction

Aas many as 80% or more of asthmatics suffer from symptoms of rhinitis,1, 2, 3, 4 and those with rhinitis alone frequently develop asthma over time.4, 5, 6, 7 Studies of patient-centered outcomes in either asthma or rhinitis that ignore their co-existence may face critical shortcomings. Indeed, an increasing body of evidence supports the construct that asthma and rhinitis represent different manifestations of a common underlying airway inflammatory disorder.8 Consistent with this construct, studies show that nasal inflammation is present in patients with asthma without rhinitis9 and that bronchial mucosal inflammation is observed in patients with rhinitis but without clinical asthma.10, 11

The assessment of health-related quality of life (HRQL) in either asthma or rhinitis has traditionally been performed using separate disease-specific instruments.12, 13 In populations in which asthma and rhinitis coexist to varying degrees, however, the use of any single disease-specific measure may fail to capture the true burden of illness. Rhinitis-specific measures tend to focus on the impact of eye and nasal symptoms, whereas asthma-specific measures focus predominantly on the effects on the lower respiratory tract. Although the co-administration of 2 separate instruments is possible, such an approach poses limitations. For example, the comparison and interpretation of results from different disease-specific measures is often complicated by overlapping item content and differences in scaling. Furthermore, the administration of 2 separate instruments is unwieldy, increasing respondent burden and fatigue.14, 15, 16

To address the challenges associated with using separate instruments for 2 overlapping conditions, Baiardini and collaborators17 developed the Rhinasthma questionnaire for use in populations with asthma or rhinitis. Rather than requiring respondents to attribute specific symptoms or problems to either their asthma or rhinitis, this integrated HRQL measure allows for the 2 conditions to be treated as different manifestations of the same disease spectrum. The Rhinasthma was originally developed in Italian,17 but it has been administered subsequently in Finnish, Swedish, and German.18, 19 Aside from original validation efforts, however, its construct validity has never been fully reassessed within larger populations or with respect to other types of health status measures. Furthermore, the psychometric integrity of the instrument has been not been previously examined in an English-speaking population.

The aims of the current study were 2-fold. First, we sought to develop an English-language adaptation of the Rhinasthma instrument and to identify item clusters that facilitate the interpretation of effects pertinent to asthma or rhinitis. Second, we sought to provide further evidence of the instrument's construct validity by examining its psychometric performance within a large, well-described population with mixed airway disease among which multiple other types of health status measures were simultaneously assessed.

Section snippets

Subject Recruitment

The study cohort reflects a merger of 2 different study groups separately recruited and previously studied independently. The flow of subject recruitment, retention, and integration is illustrated in Figure 1. Study of the merged cohort was approved by the University of California San Francisco Committee on Human Research.

In the first of the 2 parent study groups, the Asthma Rhinitis Cohort (ARC), recruitment occurred in three phases. Subjects with asthma were recruited initially through a

Study Participation

We interviewed 549 (77%) of 711 eligible subjects. Follow-up differed significantly (P < .01) between the 2 parent study groups from which subjects were recruited; 85% follow-up for the ARC and 68% for the SAC (Table 1). Overall, those interviewed were approximately 4 years older and less likely to be current or former smokers compared with those not interviewed (P < .01). We ultimately excluded four subjects because of missing data for key variables (1 for Rhinasthma and 3 for SF-12), leaving

Discussion

Although other measures have been developed for assessing HRQL in either asthma or rhinitis, the Rhinasthma is the only combined instrument designed to assess HRQL when these conditions may coexist.17, 18, 19 In this study, we thoroughly and systematically assessed the psychometric performance of an English-language version of the Rhinasthma within a large, well-described population with mixed upper and lower airway disease. Our results suggest that this version of the Rhinasthma was

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    Funding Sources: Funding provided by NIH grant R01-ES10906 and NIH grant K23-HL86585 (H.C.).

    Disclosures: The authors have nothing to disclose.

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