Asthma and Sinusitis: A Dangerous Combination

Summary
This study was conducted to see if sinusitis and allergic hay fever added to the burden of disease and suffering in asthma patients. The results showed that 10 percent of asthmatics also had hay fever, 21 percent also had sinusitis and 19 percent had all three ailments. Those with sinusitis and asthma or all three conditions visited the emergency room more frequently and all three groups spent more on healthcare. Compared to those with asthma alone, the other groups of patients missed more days of work due to their ailments. The researchers concluded, “The additional disease burden of sinusitis on asthma is greater than that of hay fever.”

Introduction
Respiratory tract problems like asthma, hay fever and sinusitis are common conditions in patients all over the world. These diseases raise the cost of healthcare and also increase the number of hospital visits for the patients. On average, hay fever affects 36 million and sinusitis affects 20 million Americans. About 5.5 percent of Americans suffer from varying degrees of asthma too. Taken together, these three conditions affect a large section of the American population. Studies have shown that there is an interaction between the three conditions, resulting in many sufferers being affected by two or more of these conditions. The basis of these conditions is an inflammation that may affect the entire respiratory tract. This study looked at the actual percentage of people with asthma who also suffered from these other ailments and the extent to which it increased healthcare-related costs.  Understanding this would help to unify the respiratory diseases and the approach to their management.

Methodology
* The study included a total of 11,813 asthma patients, whose average age was 45 years. These adults were a part of the National Health Interview that was conducted between 1997 and 2006.
* The patients were classified into four groups — asthma alone, asthma and hay fever, asthma and sinusitis and asthma, hay fever and sinusitis sufferers.
* All participants’ health records, number of hospital visits, emergency department visits, days off from work due to ailment and annual health costs were noted.

Data/Results/Key findings
* The results showed that 5,931 participants or 50 percent suffered from asthma alone. A total of 1,134 participants (10 percent) complained of asthma and hay fever, 2,461 participants (21 percent) had asthma as well as sinusitis, and 2,287 participants (19 percent) had asthma, sinusitis and hay fever. Concurrent asthma and sinusitis was more common than hay fever and sinusitis.
* Health-related costs were high in all patients who had asthma with the other two ailments. Patients with an asthma and sinusitis condition had a higher rate of emergency room visits, as compared to the patients with asthma alone or those patients with asthma and hay fever.
* Those with asthma and sinusitis, or asthma with sinusitis and hay fever had to take more days off from work (average 10 and 13 days a year respectively) compared to those with asthma alone (seven days annually). Those with asthma and hay fever lost around six days of work per year.

Next steps/Shortcomings
The authors agree that there may be mistaken over-diagnosis of conditions like sinusitis in the study group. A structured survey and patient reports were used to set up the study, which could have influenced the diagnosis and efficiency of the survey. Also, there is no clear understanding of the differences between a concomitant acute attack of sinusitis or a more chronic and long standing sinusitis. The authors suggest that future studies should involve a more accurate diagnosis of the concomitant ailments and also demarcate between the effects of a concomitant acute and chronic sinusitis.

Conclusion
This study shows that almost half of all asthmatics may suffer from hay fever and/or sinusitis. This raises their health-related expenditure as well as the number of visits to the hospital per year. The study reveals that 40 percent asthma patients also suffer from sinusitis. The study also reveals that concomitant hay fever with asthma does not affect health costs and cause a loss of working days. However, in case of asthma with both the additional ailments, the cost of healthcare and loss of working days is increased. The authors feel that this high prevalence is significant because the additional presence of sinusitis increases health costs, number of hospital visits and loss of days from work. They suggest that this association needs further studies from the point of view of research as well as economics.

For More Information:
Additional Disease Burden from Hay Fever and Sinusitis Accompanying Asthma
Publication Journal: Annals of Otology, Rhinology & Laryngology, 2009
By Neil Bhattacharyya, MD; Lynn J. Kepnes; Brigham and Women’s Hospital, Boston, Massachusetts

*FYI Living Lab Reports Are Summaries of the Original Research.
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