Rhinitis, sinusitis, and upper airway disease
Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis

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Background

Asthma and rhinitis are often comorbid conditions, and several studies have suggested that rhinitis often precedes asthma. Sensitization to allergen has been shown to be one of the strongest determinants of incident asthma, but little is known about the effects of cigarette smoking among individuals with allergic rhinitis.

Objective

We sought to evaluate the importance of cigarette smoking as an additional risk factor for incident asthma in a cohort of hospital-referred nonasthmatic adult subjects with allergic rhinitis.

Methods

The study population selected at baseline was invited for a follow-up visit 10 years later to check for possible asthma features. Categories of smokers, exsmokers, and never smokers were used in the analyses together with pack-years to calculate the level of cumulative exposure.

Results

Complete data were available from 325 patients. Smoking was significantly related to the risk of incident asthma, with the odds ratio (OR) being 2.67 (95% CI, 1.70-4.19) for univariate and 2.98 (95% CI, 1.81-4.92) for multivariate analyses. A clear dose-response association for exposure to tobacco and risk of new-onset asthma was observed in the multivariate analyses: those with 1 to 10 pack-years had an OR of 2.05 (95% CI, 0.99-4.27), those with 11 to 20 pack years had an OR of 3.71 (95% CI, 1.77-7.78), and those with 21 or more pack-years had an OR of 5.05 (95% CI, 1.93-13.20) compared with never smokers.

Conclusions

The current findings support the hypothesis that cigarette smoking is an important independent risk factor for the development of new asthma cases in adults with allergic rhinitis.

Section snippets

Study population

Medical records of patients with allergic rhinitis referred to the Outpatient Allergy Clinic of the University of Catania (Sicily) were reviewed. The subjects had to be between the ages of 18 and 40 years and not given a diagnosis of asthma at the time of referral (period between January 1990 and December 1991) to be included in the initial selection. The referred patients had to be born and residing in the province of Catania.

Our standardized diagnostic protocol at the time of referral

Results

There were 325 patients for whom all explanatory variables and asthma status at follow-up were available (Fig 1). Table I presents the proportion of subjects who subsequently had asthma based on categorical explanatory variables and smoking status. The mean age for our population at baseline was 29.1 years, and according to smoking status, the mean age of never smokers was 28.6 years, of former smokers was 27.7 years, and of current smokers was 30.2 years. It is apparent that female subjects,

Discussion

To the best of our knowledge, this is the first study that addressed the association between cigarette smoking and asthma among adults with allergic rhinitis. Our results suggest that smoking is strongly predictive of the development of new-onset asthma in adults with allergic rhinitis. Using multiple variables of smoking exposure, we found a consistently positive association between smoking and asthma. There was a dose-response association with increasing exposure to tobacco. Furthermore,

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    Supported by a personal research grant from the University of Catania (grant 60% made to R.P.) and by a grant-in-aid from Lega Italiana AntiFumo (LIAF).

    Disclosure of potential conflict of interest: R. Polosa has received research support from NeuroSearch, CV Therapeutics, and LIAF and has served as a member for the European Respiratory Society and Lega Italiana Anti Fumor. W. K. Al-Delaimy has received research support from the Flight Attendant Medical Research Institute. The rest of the authors have declared that they have no conflict of interest.

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