Background: There are few population-based studies on chronic nasal symptoms and little is known about their prevalence and determinants, or their association with allergic rhinitis and asthma. Methods: A questionnaire focused on respiratory symptoms and conditions was mailed in 2008 to 30,000 randomly selected subjects aged 16–75 years in West Sweden, 29,218 could be traced and 18,087 (62%) responded. The questionnaire included questions on self-reported allergic rhinitis, asthma, lower respiratory and nasal symptoms and possible determinants. Results: Nasal congestion was reported by 14.9% and runny nose by 13.1% of subjects. In total, 19.8% had chronic nasal symptoms. Subjects with chronic nasal symptoms had considerably more symptoms from the lower airways compared with nonrhinitic subjects and vice versa. Forty-seven percent of the subjects with chronic nasal symptoms had concurrent self-reported allergic rhinitis. Several hereditary and environmental factors were associated with chronic rhinitis, including family history of asthma [odds ratio (OR) 1.27; 95% confidence interval 1.07–1.50], family history of allergy (OR 1.74; 1.57–1.92) and current smoking (OR 1.39; 1.25–1.54). Further, chronic nasal symptoms were increasingly prevalent with an increasing degree of urbanization. Conclusion: The prevalence of chronic nasal symptoms in West Sweden was found to be high and strongly associated both with self-reported allergic rhinitis and symptoms from the lower airways. Moreover, several risk factors were identified for chronic nasal symptoms, including family history of allergy and asthma and smoking.

Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Ait-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O’Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D: Allergic rhinitis and its impact on asthma (aria) 2008 update (in collaboration with the World Health Organization, GA2LEN and allergen). Allergy 2008;63(suppl 86):8–160.
Bousquet J, Fokkens W, Burney P, Durham SR, Bachert C, Akdis CA, Canonica GW, Dahlen SE, Zuberbier T, Bieber T, Bonini S, Bousquet PJ, Brozek JL, Cardell LO, Crameri R, Custovic A, Demoly P, van Wijk RG, Gjomarkaj M, Holland C, Howarth P, Humbert M, Johnston SL, Kauffmann F, Kowalski ML, Lambrecht B, Lehmann S, Leynaert B, Lodrup-Carlsen K, Mullol J, Niggemann B, Nizankowska-Mogilnicka E, Papadopoulos N, Passalacqua G, Schunemann HJ, Simon HU, Todo-Bom A, Toskala E, Valenta R, Wickman M, Zock JP: Important research questions in allergy and related diseases: Nonallergic rhinitis: A GA2LEN paper. Allergy 2008;63:842–853.
Toren K, Olin AC, Hellgren J, Hermansson BA: Rhinitis increase the risk for adult-onset asthma – a Swedish population-based case-control study (MAP-study). Respir Med 2002;96:635–641.
Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, Wjst M, Cerveri I, Pin I, Bousquet J, Jarvis D, Burney PG, Neukirch F, Leynaert B: Rhinitis and onset of asthma: a longitudinal population-based study. Lancet 2008;372:1049–1057.
Lundback B: Epidemiology of rhinitis and asthma. Clin Exp Allergy 1998;28(suppl 2): 3–10.
Braback L, Hjern A, Rasmussen F: Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non-farming environments. A nationwide study over three decades. Clin Exp Allergy 2004;34:38–43.
Nihlen U, Montnemery P, Andersson M, Persson CG, Nyberg P, Lofdahl CG, Greiff L: Specific nasal symptoms and symptom-provoking factors may predict increased risk of developing COPD. Clin Physiol Funct Imaging 2008;28:240–250.
Bauchau V, Durham SR: Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004;24:758–764.
Cruz AA, Popov T, Pawankar R, Annesi-Maesano I, Fokkens W, Kemp J, Ohta K, Price D, Bousquet J: Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA2LEN. Allergy 2007;62(suppl 84):1–41.
Jones NS, Smith PA, Carney AS, Davis A: The prevalence of allergic rhinitis and nasal symptoms in Nottingham. Clin Otolaryngol Allied Sci 1998;23:547–554.
Montnemery P, Svensson C, Adelroth E, Lofdahl CG, Andersson M, Greiff L, Persson CG: Prevalence of nasal symptoms and their relation to self-reported asthma and chronic bronchitis/emphysema. Eur Respir J 2001;17:596–603.
Olsson P, Berglind N, Bellander T, Stjarne P: Prevalence of self-reported allergic and non-allergic rhinitis symptoms in Stockholm: relation to age, gender, olfactory sense and smoking. Acta Otolaryngol 2003;123:75–80.
Sibbald B, Rink E: Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax 1991;46:895–901.
Montnemery P, Popovic M, Andersson M, Greiff L, Nyberg P, Lofdahl CG, Svensson C, Persson CG: Influence of heavy traffic, city dwelling and socio-economic status on nasal symptoms assessed in a postal population survey. Respir Med 2003;97:970–977.
Lötvall J, Ekerljung L, Ronmark EP, Wennergren G, Linden A, Ronmark E, Toren K, Lundback B: West Sweden asthma study: prevalence trends over the last 18 years argue no recent increase in asthma. Respir Res 2009;10:94.
Ronmark EP, Ekerljung L, Lotvall J, Toren K, Ronmark E, Lundback B: Large-scale questionnaire survey on respiratory health in Sweden: effects of late and non-response. Respir Med 2009;103:1807–1815.
Lundback B, Nystrom L, Rosenhall L, Stjernberg N: Obstructive lung disease in northern Sweden: respiratory symptoms assessed in a postal survey. Eur Respir J 1991;4:257–266.
Ekerljung L, Ronmark E, Larsson K, Sundblad BM, Bjerg A, Ahlstedt S, Dahlen SE, Lundback B: No further increase of incidence of asthma: incidence, remission and relapse of adult asthma in Sweden. Respir Med 2008;102:1730–1736.
Pallasaho P, Lundback B, Meren M, Kiviloog J, Loit HM, Larsson K, Laitinen LA: Prevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and Tallinn. Respir Med 2002;96:759–769.
Population in Swedish localities 2005:, Statistics Sweden.
Edelstein DR: Aging of the normal nose in adults. Laryngoscope 1996;106:1–25.
Bauchau V, Durham SR: Epidemiological characterization of the intermittent and persistent types of allergic rhinitis. Allergy 2005;60:350–353.
Ramey JT, Bailen E, Lockey RF: Rhinitis medicamentosa. J Investig Allergol Clin Immunol 2006;16:148–155.
Passalacqua G, Ciprandi G, Canonica GW: The nose-lung interaction in allergic rhinitis and asthma: United airways disease. Curr Opin Allergy Clin Immunol 2001;1:7–13.
Rowe-Jones JM: The link between the nose and lung, perennial rhinitis and asthma – is it the same disease? Allergy 1997;52:20–28.
Droste JH, Kerhof M, de Monchy JG, Schouten JP, Rijcken B: Association of skin test reactivity, specific IgE, total IgE, and eosinophils with nasal symptoms in a community-based population study. The Dutch ECRHS group. J Allergy Clin Immunol 1996;97:922–932.
Min YG, Jung HW, Kim HS, Park SK, Yoo KY: Prevalence and risk factors for perennial allergic rhinitis in Korea: results of a nationwide survey. Clin Otolaryngol Allied Sci 1997;22:139–144.
Upton MN, McConnachie A, McSharry C, Hart CL, Smith GD, Gillis CR, Watt GC: Intergenerational 20-year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000;321:88–92.
Annesi-Maesano I, Oryszczyn MP, Raherison C, Kopferschmitt C, Pauli G, Taytard A, Tunon de Lara M, Vervloet D, Charpin D: Increased prevalence of asthma and allied diseases among active adolescent tobacco smokers after controlling for passive smoking exposure. A cause for concern? Clin Exp Allergy 2004;34:1017–1023.
Nihlén U, Greiff L, Montnemery P, Lofdahl CG, Johannisson A, Persson C, Andersson M: Incidence and remission of self-reported allergic rhinitis symptoms in adults. Allergy 2006;61:1299–1304.
Hancox RJ, Welch D, Poulton R, Taylor DR, McLachlan CR, Greene JM, Sears MR: Cigarette smoking and allergic sensitization: A 32-year population-based cohort study. J Allergy Clin Immunol 2008;121:38–42.
Polosa R, Knoke JD, Russo C, Piccillo G, Caponnetto P, Sarva M, Proietti L, Al-Delaimy WK: Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin Immunol 2008;121:1428–1434.
Rönmark E, Lundback B, Jonsson E, Jonsson AC, Lindstrom M, Sandstrom T: Incidence of asthma in adults – report from the Obstructive Lung Disease in Northern Sweden study. Allergy 1997;52:1071–1078.
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