Original Articles: Asthma, Rhinitis, Other Respiratory Diseases
Treating allergic rhinitis in patients with comorbid asthma: The risk of asthma-related hospitalizations and emergency department visits,☆☆

https://doi.org/10.1067/mai.2002.120554Get rights and content

Abstract

Background: Although asthma and allergic rhinitis commonly occur together, the nature of the association has yet to be determined. Treatments for one condition could potentially alleviate the coexisting condition. Objective: Patients with both allergic rhinitis and asthma were studied to test the hypothesis that treating allergic rhinitis reduces health care utilization for co-morbid asthma. Methods: A retrospective cohort study was carried out with 1994-1995 MarketScan claims data. The cohort was limited to patients with both allergic rhinitis and asthma, aged 12 to 60 years, who were continuously enrolled and had no evidence of chronic obstructive pulmonary disease. Allergic rhinitis treatment and asthma-related events (hospitalizations and emergency department visits) were identified. An incidence density ratio (IDR) associated with exposure to allergic rhinitis treatment was calculated. A multivariate Poisson regression was estimated, and the parameter estimates were transformed into IDRs for each explanatory variable. An allergic rhinitis treatment indicator was included in all regressions. Results: The study sample population consisted of 4944 patients with allergic asthma, approximately 73% of whom were treated for their allergic rhinitis. Asthma-related events occurred more often for the untreated group compared with the treated group, 6.6% compared with 1.3%. An IDR of 0.49 for the treatment group (P = .001) indicates that the risk of an asthma-related event for the treated group was about half that for the untreated group. Conclusion: In summary, those who were treated for allergic rhinitis have a significantly lower risk of subsequent asthma-related events (emergency department visits or hospitalizations) than those who were not treated. (J Allergy Clin Immunol 2002;109:57-62.)

Section snippets

Data

The analytical file used in this study was constructed from the 1994-1995 MarketScan databases (The MEDSTAT Group, Inc, Ann Arbor, Mich). MarketScan contains data on more than 4 million covered lives annually, representing the health-care experiences of privately insured persons employed in large companies or organizations and the covered dependents of those employees. Contributors to MarketScan come from all areas of the country but are concentrated in the north central and southern areas of

Results

The prevalence of asthma in the 1994 MedRx MarketScan database is approximately 6% and the prevalence of AR is 13%. Approximately 2% of the MarketScan population had both asthma and AR. In our final study population of 4944 patients with both conditions, approximately 73% of the patients were treated for AR. Of those who were treated, 86% (n = 3083) received at least one antihistamine and 76% (n = 2718) received at least one nasal inhaled steroid.

Table I compares the subjects who were treated

Discussion

The main result of this study is that those who were treated for AR have a significantly lower risk of subsequent asthma-related events (ED visits or hospitalizations) than those who were not treated. Qualitatively similar results were found for the risk of hospitalizations for treatment of asthma. The magnitude of the effect of treatment on both events is quite large. The prevented fraction among those exposed to treatment was 47% (1-IDR). These results imply that 47% of subjects who were

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Supported by Integrated Therapeutics Group, Inc., a subsidiary of Schering Plough.

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Reprint requests: Jodi Crystal-Peters, The MEDSTAT Group, 4401 Connecticut Ave, NW, Suite 400, Washington, DC 20008.

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