Evaluating the Bidirectional Association Between Allergic Rhinitis and Bronchial Asthma

Abstract

Background: Allergic rhinitis (AR) and bronchial asthma (BA) are chronic inflammatory airway diseases that frequently coexist, reflecting the “united airway†concept. Patients with AR are at increased risk of developing asthma, while a significant proportion of asthmatics also suffer from AR. Understanding this bidirectional association is crucial for early diagnosis and integrated management. Objective: To know association between allergic rhinitis (AR) and bronchial asthma (BA) by determining the incidence of BA in patients of AR and the incidence of AR in patients of BA. Methodology: A cross-sectional observational study conducted in a tertiary care hospital over a period of twelve months enrolled a total of 240 patients, including 120 patients with clinically diagnosed AR and 120 with BA. The diagnosis of AR was made according to the ARIA guidelines, and asthma was diagnosed using the GINA criteria using a clinical assessment and spirometry. A detailed history, clinical examination, use of nasal endoscopy, an absolute eosinophil count, serum IgE, and spirometry were done. The incidence of BA in patients with AR and AR in patients with BA was ascertained. Factors triggering the disease and temporal sequence of the onset were also studied. Results: Among 120 AR patients, 59.2% had coexisting asthma, while 76.7% of asthmatics had AR. In AR patients who developed asthma, the mean interval between disease onsets was 2.9 years, with AR preceding asthma in most cases. Dust (85.0%) and pollen (31.7%) were significantly more frequent triggers in AR compared to BA (65.0% and 13.3%; p<0.01). Conclusion: This study confirms a strong bidirectional association between AR and BA, with AR often preceding asthma. Routine screening and integrated management of both conditions are recommended.