Abstract

 


 


Asthma prevalence is rising globally and is expected to further rise according to the WHO for the future decade. Many studies had shown that asthma is associated with allergic rhinitis and it showed a better outcome if allergic rhinitis is treated earlier.


 


To spot the light on the prevalence of allergic rhinitis &asthma among adolescents aand find the association between them.


 


Cross section study enrolled adolescents with age 18-21years both male and female from a college of medicine in Baghdad. Data collection done by using self-ministered questionnaire,713 students were involved , with total male of 294,while females were 419 ,Prevalence of allergic rhinitis 58.5% in females and 52.7% in females, sex was not associated with allergic rhinitis. Prevalence of asthma in total sample was 4%.and it was associated with allergic rhinitis p<0.5.In Conclusion: Allergic rhinitis prevalence is increasing in Iraqi adolescents' regardless sex, and it is associated with asthma.

Introduction:

Allergic rhinitis may be defined as" paroxysms of sneezing, rhinorrhoea, and nasal obstruction, often accompanied by itching of the eyes, nose, and palate. Postnasal drip, cough, irritability, and fatigue”. ( 1 )

Asthma is" a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation". ( 2 )

Allergy can take the form of variable manifestations , among them are allergic rhinitis &asthma which are often associated, yet their association can sometimes be undiagnosed in such away one can prevail the other.( 3,4).

Allergic rhinitis occurs in a prevalence of 10-30 % of USA & other developed countries, although lower but developing countries also show significant rising numbers. ( 5 )

On the other hand asthma has been expressing a rising prevalence in both developed & developing countries, this is documented by the fact that it has been expected by the WHO to have an excess of asthmatic people by 100 million above the already diagnosed 300 million globally by the year 2025. Such a number would create a financial burden for the high income countries because of hospitalization of management of severe asthma. While for the middle & low income countries would lead to future lack of school performance because of repeated absenteeism specifically for those undiagnosed during infancy.(6 )

Allergic rhinitis is not only associated with asthma but also increase its severity, never the less treating it will massively improve asthma outcome so that it is recommended to treat allergic rhinitis in asthmatic patients to improve the quality of life.( 7 )

Prevalence of asthma in Iraq according to the WHO & Iraqi ministry of health in 2006 was 5% in adolescents & young adults, showing more than 3 folds rise within a decade up to 17.4 %.( 8, 9).

Iraq is famous of range of deserts & millions of date palms, sand storms from deserts are continuous during summer months causing a significant number of hospital admissions because of severe asthmatic attacks; besides date palm pollens also evoke allergy in the form of allergic rhinitis. (10, 11).

Objective of the study:

To throw light on the prevalence of allergic rhinitis & asthma among adolescents& then to find the association between them.

Methodology:

Study design

Cross sectional study with analytic base.

Time of study:

The study had been initiated since March the 13th 2016 May 31st 2016 till September the 23rd 2018.

Population study:

The study was directed towards the students of medical college in Baghdad who were between 18-21 years of age both males and females.

Data collection:

This was done by using a self administrated questionnaire composed of questions concerning allergic rhinitis & asthma, the filling time lasted 10-15 minutes after taking the approval of participation from each student.

Data analysis:

Data entry was done using Excel, then percentages were calculated as well as the prevalence of allergic rhinitis among the study sample &the prevalence of asthma among allergic rhinitis subjects.

Graphs & figures were done and the association was calculated using Chi square test.

Results & Discussion:

The gulf countries witness an ascending prevalence of asthma & comorbid allergic rhinitis in comparison to the neighboring countries, besides an individual with allergic rhinitis is 3 times at risk to develop asthma more than the individual without allergic rhinitis. Since asthma according to the WHO resulting in 15 million disability adjusted life-years lost and around 250000 deaths globally & the fact that barely one study that assess the prevalence of allergic rhinitis & asthma & probe the relation between them among Iraq young adults a decade ago & with rapid environmental changes in Iraq since the American invasion , & the drought due to water policy of Turkey & Iran ,such changes occurred in the form of desertification & hence more sandstorms leading to more hospital admissions which in turn possess poor equipment & poor management for acute severe asthmatic attacks so more morbidity & eventually mortality, this necessate the need to such research so that to spot the light on the enormous size of the problem . (12, 13, 14, 15).

The sample size included 713 students, with total male of 294, while females were 419

Figure 1 Graph: 1 below expressing their percentages.

Sample counts 155 were allergic males showing a percentage of 52.7 (graph 2), while the female’s percentage 58.5. ( Graph 3 ), although females predominates, the difference between male and female in allergic rhinitis was negligible.

Figure 2 Graph 2: Percentage of allergic rhinitis in adolescent male

Figure 3 Graph 3: Percentage of allergic rhinitis in adolescent females

Table 1: To prove if there was an association between allergic rhinitis and gender, Chi square test was calculated in Table 1 below:

Total Non allergic Allergic Gender
294 139 155 Males
419 174 245 Females
713 313 400 Total

3206 The p-value is 127669 The result is not significant at p < 05, our study results showed a similar result in a study done in Italy in which there was no significant association between allergic rhinitis and gender, ( 16)

On the contrary, the association was significant in a study done in Pakistan between gender and allergic rhinitis. ( 17 ). Both of our study and the Italian study were community based and with larger sample size in comparison to the Pakistani study which was patient based and with a smaller sample this might justify the different findings.

Asthma occurred in a percentage of 4% in our sample (graph 4)

This is equal to a study done in Saudi Arabia which also showed an asthma prevalence of 4%. ( 18 ).

Table 2: Asthma was significantly associated with allergic rhinitis,

Non Asthmatic Asthmatic
400 374 26 Allergic Rhinitis
313 307 6 Non Allergic Rhinitis
713 681 32 Total

58, the P value is003354The result is significant at p<05,so as the study in Iran with p value <005 ( 19)

In a community based study in Iraq on 20 08, the Odds ratio was found to be 14.9 p value <.001.( 20 ).

This is also compatible with a study done in Turkey, Iran in which asthma was significantly associated with allergic rhinitis, odds ratio (OR), 3.98;

95% CI, (1.81–8.76). ( 21 ).

Also asthma symptoms was strongly associated with allergic rhinitis (OR 2.5 p value < 0.001) in the Saudi Arabia study that enrolled 3073 adolescent students both males &females. ( 22 ).

In Peru, allergic rhinitis occurred in 66.4% of asthmatic subjects & it was positively associated with inadequately control of asthma (adjusted prevalence ratios1.53 (95%CI1.19-1.98). ( 23 ).

Conclusion:

Allergic rhinitis is a growing problem in Iraq, as it has augmented over the last decade going hand in hand with the changes that occurred on of the Iraqi environment .Allergic rhinitis is associated with asthma but was not found to be associated with gender.

Asthma prevalence has shown no enormous changes since the last decade, to assess these fact larger samples are required in future studies.