The impact of nasal congestion and rural residence on pulmonary function and asthma control in adults with asthma and allergic rhinitis

Purpose. The purpose of this study was to examine the impact of nasal congestion on pulmonary function in rural and non-rural adults with asthma and allergic rhinitis, and to determine if acute onset nasal congestion can serve as predictor of worsening asthma.;Design. A retrospective chart review was conducted at 3 clinical sites along the NY/PA border resulting in a study sample of 117 patients (95% allergist subspecialty). Nasal congestion measures (presence, duration, severity and combined duration/severity) were examined for their relationship with pulmonary function scores (PEF% predicted) and asthma control.;Findings. Rural residence (p<.50), age (p<1.00) and gender (p<.50) were not related to pulmonary function or asthma control. However, presence and severity of nasal congestion were strongly predictive of pulmonary function, p < .05. Presence, duration and severity of nasal congestion were also predictive of asthma control, p < .05. The risk of uncontrolled asthma increased 6-fold with the presence of nasal congestion. The highest risks for uncontrolled asthma were associated with moderate nasal congestion severity (8-fold increase) and duration of > one week (9-fold increase). A positive correlation was also found between pulmonary function and immunotherapy, p<.05, which was controlled for in the analysis.;Conclusion. The presence of nasal congestion produced statistically significant decreases in pulmonary function. Uncontrolled asthma risks varied 6 to 16-fold, with the greatest risk associated with moderate nasal congestion of greater than one week duration. Overall, the greater the duration and severity of acute phase nasal congestion, the greater the decrease in pulmonary function. Nasal congestion severity was the best indicator or predictor of worsening asthma. Rural residence, in this study population, did not significantly affect asthma control outcomes.