FIGURE 5
Patient-rated impact of symptoms on work productivity
Patients with nasal allergies were asked: (A) Thinking about your productivity at work on a scale from 0 to 100, where 100 means 100% productivity, where would you rank your productivity on days when you don’t have nasal allergy symptoms? (B) Where would you rank your productivity on the same scale from 0 to 100, where 100 means 100% productivity, when your nasal allergies are at their worst?
Base: All respondents, N = 400.
Nasal Allergies and Other Activity Limitations
In order to estimate the impact of nasal allergies on specific activities for adults with AR, both samples were asked how much their health limited them in 5 activity areas. Nearly twice as many AR patients said that their health limited them in outdoor activities (44% vs 21%) and in indoor activities (20% vs 11%), compared with adults without nasal allergies. Similarly, more AR patients than adults without nasal allergies felt that their health limited them in social activities (41% vs 21%), doing well at work (22% vs 14%), and having or playing with pets (24% vs 8%) (FIGURE 6).
FIGURE 6
Impact of nasal allergies on specific activities: Nasal allergy vs nonallergy*
All respondents were asked: How much do you feel that your health limits what you can do in the following areas (doing well at work, social activities, having or playing with pets, outdoor activities, indoor activities)? Do you feel your health restricts you frequently, sometimes, rarely, or never?
Base: All respondents, N = 522; *Pearson chi-square, P ≤ 0.05.
Nasal Allergies and Emotional Burden
Nasal allergies pose an emotional burden of disease, as well as the physical burden of disease. Patients with AR were asked how often they felt certain ways during their worst month. Overall, the majority of AR patients said that they frequently or sometimes experienced emotional problems during the worst month of symptoms: 67% said that they frequently or sometimes felt irritable, 60% said they felt miserable, 28% said they felt depressed, 25% said they felt anxious, and 15% said they felt embarrassed. Even more noteworthy, 85% reported that they frequently or sometimes felt tired during the worst month of allergy symptoms (FIGURE 7).
FIGURE 7
Patient-rated emotional burden during the worst month of symptoms
Patients with nasal allergies were asked: During the worst month of allergy symptoms, how often do you feel (depressed, irritable, tired, embarassed, miserable, or anxious)— frequently, sometimes, rarely, or never?
Base: All respondents, N = 400.
Discussion
NASAL was the first national survey to measure the burden of disease of AR in the US by comparing the health status of adults with current AR, nasal allergies, or hay fever with a national sample of adults without nasal allergies. The survey clearly demonstrated that nasal allergies imposed a considerable burden. Only a minority of AR patients in this study considered their health to be very good or excellent, and more than 2 in 5 patients (41%) said that their health kept them from working, limited the kind or amount of work they do, or limited them in some other way.
Furthermore, the survey showed that patients were not just troubled by the presence of their AR symptoms, but that AR had added effects on various aspects of their daily life. They were troubled by not being able to sleep well at night because of their symptoms and reported being fatigued and distracted during the day. Nasal problems, particularly nasal congestion and rhinorrhea, led to disordered nighttime breathing and sleep disturbances.10-12 Indeed, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines included sleep disturbances as a key factor in their definition of severity based on the impact of rhinitis on HRQoL.13 The widespread experience of fatigue among nasal allergy patients was certainly related to sleep disruption associated with nasal allergy symptoms. It is also possible that rhinitis-disturbed sleep contributed to the very high proportion of AR patients who, in this survey, reported feeling irritable and miserable and, in the more serious cases, has been a cause of feelings of anxiety and depression, reported by up to one-quarter of AR sufferers.
Importantly, NASAL also showed that the burden of disease of AR imposed a social and economic cost on the patient and on society through its impact on work performance. In addition to keeping some allergy sufferers from working, nearly twice as many AR patients reported that their health limited them frequently or sometimes from doing well at work compared with adults without nasal allergies and their estimated productivity dropped from an average of 89% on days when they did not have nasal symptoms to 71% on days when their nasal symptoms were at their worst. These results were in agreement with those of other studies, which reported work impairment in up to 60% of patients with seasonal AR and up to 40% of those with perennial AR.14 One large US survey published in 2006 found that 55% of employees experienced AR symptoms for an average of 52.5 days per year, was absent from work 3.6 days per year because of AR, and were unproductive in the workplace for 2.3 hours per day because of AR symptoms. The mean total productivity (absenteeism + presenteeism) losses per employee per year were higher ($593) for AR than for stress, migraine, depression, arthritis/rheumatism, anxiety disorder, respiratory infections, hypertension, diabetes, asthma, and coronary heart disease.15