Abstract
Purpose
The aim of the study was to compare the efficacy of instruments to assess quality of life (QoL) in patients with moderate to severe persistent allergic rhinitis (PAR) vs intermittent allergic rhinitis (IAR).
Materials and Methods
There were 106 patients with PAR and 99 with IAR and 50 healthy subjects in the control group. Questionnaire results were obtained using the Medical Outcomes Survey Short Form 36 (SF-36), a visual analog scale (VAS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) and were analyzed using correlational analysis.
Results
Correlations between the total scores and most domains of the 3 questionnaires were stronger in patients with PAR than in those with IAR, although the difference between groups was significant only for the RQLQ ( P < .01). The QoL was worse in the PAR subgroup than in the IAR subgroup in the domains of social functioning in the SF-36 and for items of sleeping problems and activity limitations in the RQLQ. There were significant correlations between RQLQ and VAS-eye symptoms in the PAR subgroup but not in the IAR subgroup.
Conclusions
The 3 questionnaires differentiated patients with AR from the healthy population, with significant but weak correlation with each other. The correlations were higher in patients with PAR than in those with IAR. The moderate to severe PAR has a greater effect on quality of life than IAR. Eye symptoms affected the QoL more in patients with PAR than in those with IAR.
1
Introduction
Allergic rhinitis (AR) is one of the most common chronic nasal diseases, affecting about 10% to 25% of the global population . The prevalence of AR is about 17% in Italy, 29% in Belgium, and 23% in Europe . In China, the latest epidemiological study found the prevalence of AR to be 11.1%, ranging from 8.7% to 24.1% . These data might be underestimates. Patients with AR usually have annoying symptoms, such as nasal problems (congestion, rhinorrhea, itching, and sneezing) and eye discomfort (itching and weeping), and are bothered by concomitant symptoms such as headaches, thirst, sleep disorders, and fatigue . Allergic rhinitis usually accompanies some syndromes or diseases, including acute or chronic rhinosinusitis, nasal polyps, otitis media with effusion, and hearing impairments . Allergic rhinitis is a potential risk factor for the orbital complications of acute rhinosinusitis, especially in children . It is widely acknowledged that AR leads to bothersome symptoms in the affected organs and seriously impairs each patient’s quality of life (QoL).
QoL can be assessed using 2 types of questionnaires. For patients with AR, the rhinoconjunctivitis QoL questionnaire (RQLQ) is one of the most widely used disease-specific questionnaires, and its validity and reliability have been demonstrated . The Medical Outcomes Survey Short Form 36 (SF-36) is used frequently in generic assessment of QoL . A visual analog scale (VAS) is a quantitative measure used for evaluating a patient’s perception of many diseases and can be used for assessing the decongestion test in patients with persistent allergic rhinitis (PAR) and the symptom severity for those with AR .
Terreehorst et al reported a moderate correlation between the SF-36 and RQLQ evaluations. Bousquet et al found that the VAS and the RQLQ total scores were highly significantly correlated in patients with AR. Using the RQLQ and a generic 15-dimensional instrument, Petersen et al showed that patients with moderate to severe AR have a significantly lower QoL than patients with mild AR.
Although disease-specific and generic instruments have been used widely to evaluate the QoL of patients with AR, it is not clear how the specific symptoms relate to the general health status in patients with moderate to severe PAR or with intermittent allergic rhinitis (IAR). This study aimed at testing the correlations between the RQLQ, SF-36, and VAS in patients with different types of AR. We also compared the efficacy of the instruments in discriminating between patients with moderate to severe PAR and IAR.
2
Materials and methods
The present study was performed from October 2008 to September 2009 at the outpatient department of the West China Hospital, Sichuan University, P. R. China. And it was approved by the ethical committee in West China Hospital, Sichuan University. Diagnosis of AR was made by signs and symptoms according to the guidelines set out in Allergic Rhinitis and its Impact on Asthma (ARIA) and a medical history of any positive results in skin prick tests with standardized allergens. The definitions of IAR and PAR, and the degree of AR symptoms (mild, moderate to severe), were adopted from the ARIA. All recruits signed an informed consent form and agreed to participate in this investigation. A healthy control group of people with no symptoms of rhinitis and negative results in skin prick tests was also recruited. Patients and controls were asked to complete the self-administered RQLQ, VAS, and SF-36. All 3 QoL questionnaires were validated Chinese language versions .
All data from questionnaires were computerized for statistical analysis using SPSS version 12.0 (SPSS, Inc, Chicago, IL). A 1-sample Kolmogorov-Smirnov test was used to examine the distribution of scores. Correlations between the 3 instruments or their domains were examined using Spearman’s rank order test in the total cohort of patients and all subgroups. Differences between subgroups were compared using nonparametric Mann-Whitney U tests. All tests were 2-tailed, and the level of significance was set at P < .05.
2
Materials and methods
The present study was performed from October 2008 to September 2009 at the outpatient department of the West China Hospital, Sichuan University, P. R. China. And it was approved by the ethical committee in West China Hospital, Sichuan University. Diagnosis of AR was made by signs and symptoms according to the guidelines set out in Allergic Rhinitis and its Impact on Asthma (ARIA) and a medical history of any positive results in skin prick tests with standardized allergens. The definitions of IAR and PAR, and the degree of AR symptoms (mild, moderate to severe), were adopted from the ARIA. All recruits signed an informed consent form and agreed to participate in this investigation. A healthy control group of people with no symptoms of rhinitis and negative results in skin prick tests was also recruited. Patients and controls were asked to complete the self-administered RQLQ, VAS, and SF-36. All 3 QoL questionnaires were validated Chinese language versions .
All data from questionnaires were computerized for statistical analysis using SPSS version 12.0 (SPSS, Inc, Chicago, IL). A 1-sample Kolmogorov-Smirnov test was used to examine the distribution of scores. Correlations between the 3 instruments or their domains were examined using Spearman’s rank order test in the total cohort of patients and all subgroups. Differences between subgroups were compared using nonparametric Mann-Whitney U tests. All tests were 2-tailed, and the level of significance was set at P < .05.
3
Results
A total of 205 patients with AR were recruited in this prospective study. The median age of the subjects was 33 years (range, 18–54 years): 111 (54%) men and 94 (46%) women, among whom 51% had PAR, and 49% had IAR. There were 50 healthy control subjects: 26 men and 24 women with a median age of 29.5 years (range, 19–42 years).
The total scores of the RQLQ, VAS, and SF-36 were significantly correlated with each other in the total cohort of patients and in the 2 subgroups ( Table 1 ). The highest correlation coefficients between instruments were found in the PAR subgroup, followed by the total cohort of patients and the IAR subgroup.
| PAR | IAR | AR | |
|---|---|---|---|
| SF-36 vs RQLQ | –0.644 | –0.500 | –0.574 |
| SF-36 vs VAS | –0.403 | –0.403 | –0.340 |
| RQLQ vs VAS | 0.622 | 0.403 | 0.527 |
As shown in Tables 2 and 3 , for the 2 subgroups, most of the domains in the RQLQ showed weak to moderate correlations with the SF-36. Similar outcomes were observed between most domains of the SF-36 and the VAS scores for nasal (VAS-nasal) symptoms in the PAR group. Unexpectedly, the nasal problem (NP) and emotional symptom (ES) domains in the RQLQ and the VAS-nasal symptoms did not correlate with the SF-36 in the IAR subgroup. Significant correlations between most domains of the RQLQ and the VAS-nasal symptoms were found in both subgroups. Except for the activity limitation (Act) item, most domains of the RQLQ and the VAS-eye symptoms correlated significantly with each other in the PAR subgroup but not in the IAR subgroup. In the 2 subgroups, there were no significant correlations between most domains of the SF-36 and the VAS-eye symptoms. The correlation coefficients were higher for most domains of all QoL instruments in the PAR subgroup than in the IAR subgroup.
| RQLQ | VAS | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| PAR | SP | NN | PP | NP | ES | ED | Act | Nasal | Eye |
| PF | –0.259 | –0.341 | –0.266 | –0.216 | –0.28 | –0.362 | –0.442 | –0.197 | NS |
| RP | –0.325 | –0.42 | –0.243 | –0.227 | NS | –0.451 | –0.329 | –0.274 | NS |
| BP | NS | –0.269 | NS | NS | NS | –0.272 | NS | NS | NS |
| GH | –0.365 | –0.378 | –0.29 | –0.309 | NS | –0.402 | –0.228 | –0.269 | NS |
| VT | –0.458 | –0.373 | –0.263 | –0.386 | –0.221 | –0.34 | –0.221 | –0.318 | NS |
| SF | –0.289 | –0.31 | –0.289 | –0.29 | –0.204 | –0.395 | –0.312 | –0.307 | NS |
| RE | –0.421 | –0.472 | –0.355 | –0.246 | –0.318 | –0.483 | –0.31 | –0.382 | –0.263 |
| MH | –0.409 | –0.257 | –0.341 | –0.345 | –0.332 | –0.362 | –0.28 | –0.319 | NS |
| IAR | |||||||||
| PF | –0.267 | –0.325 | NS | NS | NS | –0.24 | –0.234 | NS | NS |
| RP | NS | –0.473 | –0.285 | NS | NS | –0.433 | –0.246 | –0.217 | NS |
| BP | –0.205 | –0.466 | NS | NS | NS | –0.376 | –0.329 | NS | NS |
| GH | NS | –0.267 | NS | NS | NS | NS | NS | NS | NS |
| VT | NS | –0.361 | NS | NS | NS | –0.369 | NS | NS | NS |
| SF | –0.201 | –0.426 | NS | NS | NS | –0.34 | NS | NS | NS |
| RE | NS | –0.457 | –0.262 | NS | NS | –0.406 | –0.209 | –0.206 | NS |
| MH | –0.252 | –0.287 | NS | NS | NS | –0.303 | NS | NS | NS |
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