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.