How should I approach the management of rhinitis in a patient with asthma or other comorbidities?

In managing rhinitis in a patient with asthma or other comorbidities, assess for underlying allergic or vasomotor rhinitis as nasal symptoms can exacerbate respiratory conditions such as asthma and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) ².

First-line treatment for allergic rhinitis includes intranasal corticosteroids and antihistamines (intranasal or non-sedating oral), either alone or in combination, with intranasal corticosteroids being the most effective option ¹.

For patients with moderate to severe or persistent allergic rhinitis impacting quality of life or asthma control, intranasal corticosteroids or a combination of intranasal corticosteroid and intranasal antihistamine should be considered ¹.

In patients with comorbid OSAHS or obesity hypoventilation syndrome (OHS), initial treatment of rhinitis should be with topical nasal corticosteroids or antihistamines for allergic rhinitis, or topical nasal corticosteroids for vasomotor rhinitis ².

If rhinitis symptoms persist despite initial treatment or if anatomical obstruction is suspected, refer to an ear, nose, and throat (ENT) specialist ².

Advise patients on allergen avoidance strategies tailored to their specific allergens, such as pollen or house dust mite, and consider nasal saline irrigation to reduce symptoms ¹.

For patients using CPAP for OSAHS, be aware that rhinitis can affect tolerance; switching from a nasal to an orofacial mask and adding humidification may improve compliance ².

When prescribing intranasal corticosteroids in children or patients with comorbidities, use the lowest effective dose and monitor for side effects, as systemic absorption is minimal with agents like mometasone furoate and fluticasone propionate ¹.

Continue treatment as long as exposure to allergens persists and step up management if symptoms are uncontrolled after 2–4 weeks ¹.