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Reported symptoms have the advantage of not being dependent on local health service practice and local use of diagnostic terms and are more appropriate for surveys, particularly when these are multicentre or, as in this case, multinational. Of the studies that have used physician diagnosis of disease, the Tucson longitudinal study has shown that chronic cough with wheeze is associated with doctor-diagnosed ��sinus trouble�� (20) in children, and find more has shown a greater incidence of adult-onset asthma among those who reported ��blocked or stuffy nose in the absence of a cold�� with physician diagnosed ��sinus troubles��(4). We recognize that allergic rhinitis and CRS coexist, that the former may lead to the latter and that ��chronic rhinosinusitis��, like ��asthma�� reflects several phenotypes. Even though both rhinitis and sinus disease are associated with asthma, a review of patients with asthma taking part in trials of asthma therapy buy AG-221 suggested that it was the co-existence of chronic rhinosinusitis, not allergic rhinitis, that was associated with lower asthma-related quality of life (21). We found that chronic rhinosinusitis without allergic rhinitis was associated positively with adult-onset asthma and negatively with childhood-onset asthma. As with all studies that rely on recall there may be misclassification of the reported age at which asthma first began with a proportion classifying their disease as adult-onset when, in fact, they had symptoms in childhood (22). This could result in overestimation of the association of adult-onset disease with CRS and underestimation for childhood-onset disease. Our results are compatible with a small clinical study of adults with asthma in which all those who recalled their asthma beginning before the age of 16 (but not those with Succimer adult-onset asthma) reported they had asthma before they developed sinusitis (23) Chronic rhinosinusitis with polyps has been specifically associated with asthma (24, 25). We have no direct information on polyps, but we did ask about loss of smell, a symptom strongly associated with polyposis (26). We found a much stronger association of asthma with ��CRS with loss of smell�� (OR: 4.25; 95% CI: 3.74�C4.71) than of asthma with ��CRS without a loss of a sense of smell�� (OR: 2.88; 95% CI: 2.59�C3.21) (P-value for the difference