Introduction
An approximate 300 million people worldwide are suffering from asthma,
with Indians constituting nearly 12% of the affected population, i.e.
37.9 million1. An estimated 2% to 25% children and
nearly 40% adults also suffer from allergic
rhinitis(AR)2. Association of asthma with AR is seen
in 15% to 38% of patients, and asthma with nasal symptoms in 6% to
85% patients respectively. In addition, uncontrolled moderate-to-severe
AR affects asthma control making AR a significant risk factor for
asthma2.
The first breakthrough study was the International Study of Asthma and
Allergic Diseases in School Children (ISAAC) phase I carried out in
1995. Global prevalence, severity, and association with environmental
risk factors of asthma, AR, and eczema were studied using a standardized
validated tool and uniform methodology. Identifying the etiological
factors formed the core basis of ISAAC phase II (1998) while the ISAAC
phase III study (2001-2003) imitated phase 1 for evaluating 1.9 million
children from 98 countries and found a wide heterogeneity in the
prevalence of AR and eczema globally. In
India, the ISAAC phase III showed the prevalence of AR and ARC as 11.3%
(7.3%, 26.7%) and 3.9% (1.8%, 8.6%), respectively, in the
6-7-year-olds and 24.4% (4.1%, 45.7%) and 10.9% (0.9%, 23.6%) in
the 13-14-year-olds, respectively3.The Global Asthma
Network (The GAN) continued the work that ISAAC (concluded 2012) had
initiated and extended the survey to include parents of children
participating in the study to bridge the data gap about the prevalence
of asthma, AR, and eczema in adults especially in the low- and
middle-income countries1.
Patients, suffering from allergic rhinitis, not only manifest
troublesome nasal symptoms, such as, rhinorrhea, nasal congestion,
sneezing, but also, often have to endure distressing non-nasal symptoms
including headaches, fatigue, excessive thirst and sleep
deprivation4. These allergies sometimes impede
learning in children leading to reduced productivity and
concentration5.
Quality of life (QOL) score is increasingly being used as the measure
for determination of effectiveness of a particular treatment procedure
for childhood asthma. Besides patients’ physical health, this assessment
encompasses the effects of disease on every aspect of patient’s daily
life, trying to assess their emotional, financial, and social well-being
too6. There is no unanimity among the health
fraternity whether the severity of disease alters the QOL of asthmatic
children for the worse. Some studies do not consider any correlation
between symptoms of poorly managed chronic asthma such as, wheezing, or
frequent sleep disruption, including night awakenings etc., which
adversely affect patients and their caregivers’ daily life, and
children’s QOL indices, whereas other studies factor them in their
results7.
The health-related quality of life (QOL) of rhinitis and asthmatic
patients are deemed to be affected by demographic and socio-economic
factors. In India, underdiagnosis, inadequate treatment, deceptive
symptomatic names, such as ‘cough’, ‘saans’ and ‘dama’ , a wide gap in
healthcare facilities across different economic strata, and a lack of
health insurance form important prevalent challenges. Cheaper oral
formulations vanquish the widely available inhaled corticosteroids
(ICS), β2-agonist and combination inhalers present in the market.
Inadequate treatment still leads to yearly hospitalizations in more than
25% of patients as the myths of inhalers being habit-forming drugs are
still widespread in our society.(8,9).
Multiple studies during the pandemic reported infection, severity, and
mortality of COVID-19 among patients with AR and/or asthma did not have
any significant association with the ongoing long term medications. AR
(all ages) and asthma (aged <65) were found to be protective
factors against COVID-19 infection , but asthma did increase the risk
for COVID-19 hospitalizations10. A Systematic Review
and Meta-Analysis based on the ‘Association between Allergic Rhinitis
and COVID-19’ analyzed the results of nine studies and found the
prevalence of AR in patients with COVID-19 was 0.13 with an
overall I 2 of 99.77% supporting that COVID-19
patients with AR are less prone to severe disease (odds ratio
[OR] = 0.79, 95% CI, 0.52–1.18, ) and hospitalization (OR = 0.23,
95%CI, 0.02–2.67, ) than patients without AR11.
Since there have been no studies available from this part of world to
evaluate the QOL in children and their caregivers with varying severity
of respiratory allergies, the objective of this study, planned by us,
was to assess the QOL in children and their caregivers suffering from
allergic rhinitis and/or asthma. The study hopes to highlight the QOL of
both children and their caregivers and help provide inputs for better
utilization of resources to achieve optimal treatment.