Pesquisa associa a rinite ao desenvolvimento de asma em adultos

Estudo publicado por “The Lancet” indica que a rinite, alérgica ou não, é um importante fator de prognóstico da asma nos adultos. Médicos da equipe de epidemiologia do Instituto Nacional da Saúde e Pesquisas Médicas de Paris verificaram durante mais de oito anos o começo dos ataques de asma em pacientes adultos de entre 20 e 44 anos. Por Henrique Cortez*, do Ecodebate.

Foi diagnosticada nos pacientes uma possível rinite e suas reações alérgicas a diversas plantas, fungos e pó, o que serviu para classificá-los depois em diferentes grupos.

Os dados levam em conta país, sexo, idade, índice de massa corporal, capacidade pulmonar, histórico de asmáticos na família e sua condição de fumantes ou não.

Assim, foi possível demonstrar que as pessoas com simples alergias tinham 63% mais de chances de desenvolver asma que os do grupo de controle, as pessoas com rinite não-alérgica, mais de duas vezes e meia; e as que têm rinite alérgica, 3,5 vezes mais.

Rhinitis, with or without allergies, is linked to adult-onset asthma
Using data from the European Community Health Survey, authors’ of an Article investigated the onset of asthma in adult patients aged 20-44 years with allergic and non-allergic rhinitis. They found that rhinitis is a powerful predictor of adult-onset asthma. …..

The Lancet 2008; 372:1049-1057
DOI:10.1016/S0140-6736(08)61446-4

Rhinitis and onset of asthma: a longitudinal population-based study
Rafea Shaaban MD a, Mahmoud Zureik MD a , David Soussan MS a, Catherine Neukirch MD a b, Joachim Heinrich PhD c, Jordi Sunyer MD d, Matthias Wjst MD c, Isa Cerveri MD f, Isabelle Pin MD g h, Jean Bousquet MD i, Deborah Jarvis MBBS e, Peter G Burney MD e, Françoise Neukirch MD a and Bénédicte Leynaert PhD a

Summary
Background
A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8·8-year period.

Methods
We did a longitudinal population-based study, which included 29 centres (14 countries) mostly in western Europe. Frequency of asthma was studied in 6461 participants, aged 20–44 years, without asthma at baseline. Incident asthma was defined as reporting ever having had asthma confirmed by a physician between the two surveys. Atopy was defined as a positive skin-prick test to mites, cat, Alternaria, Cladosporium, grass, birch, Parietaria, olive, or ragweed. Participants were classified into four groups at baseline: controls (no atopy, no rhinitis; n=3163), atopy only (atopy, no rhinitis; n=704), non-allergic rhinitis (rhinitis, no atopy; n=1377), and allergic rhinitis (atopy+rhinitis; n=1217). Cox proportional hazards models were used to study asthma onset in the four groups.

Findings
The 8·8-year cumulative incidence of asthma was 2·2% (140 events), and was different in the four groups (1·1% (36), 1·9% (13), 3·1% (42), and 4·0% (49), respectively; p<0·0001). After controlling for country, sex, baseline age, body-mass index, forced expiratory volume in 1 s (FEV1), log total IgE, family history of asthma, and smoking, the adjusted relative risk for asthma was 1·63 (95% CI 0·82–3·24) for atopy only, 2·71 (1·64–4·46) for non-allergic rhinitis, and 3·53 (2·11–5·91) for allergic rhinitis. Only allergic rhinitis with sensitisation to mite was associated with increased risk of asthma independently of other allergens (2·79 [1·57–4·96]).

Interpretation
Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma.

Funding
UCB Institute of Allergy and Agence Nationale de la Recherche.

Affiliations

a. Unit 700 Epidemiology, National Institute of Health and Medical Research (INSERM), Paris, France
b. Department of Pneumology, Bichat Teaching Hospital, Paris, France
c. Institute of Epidemiology, Helmholtz Zentrum München—National Research Centre for Environment and Health, Neuherberg, Germany
d. Centre for Research in Environmental Epidemiology (CREAL), Institut Municipal d’Investigació Mèdica, Barcelona, Spain
e. Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, UK
f. University of Pavia, Pavia, Italy
g. Unit 823, National Institute of Health and Medical Research (INSERM), Grenoble, France
h. Grenoble Teaching Hospital, Grenoble, France
i. Department of Pneumology, Hospital Arnaud De Villeneuve, Montpellier, France

Correspondence to: Mahmoud Zureik, Epidémiologie des Maladies Respiratoires, INSERM, Unité 700, Faculté de Médecine Paris 7, site Bichat, BP 416, 75870 Paris Cedex 18, France

* Com informações da revista The Lancet e da Agência EFE.

[EcoDebate, 20/09/2008]