Relationship between chronic rhinosinusitis exacerbation frequency and asthma control

Abstract

Objectives/hypothesis: To determine the association between the frequency of acute chronic rhinosinusitis (CRS) exacerbations (AECRS) and the degree of asthma control in asthmatic CRS patients.

Study design: Cross-sectional study.

Methods: We prospectively recruited 108 asthmatic CRS patients as participants. Asthma control was assessed using the Asthma Control Test (ACT). The frequency of AECRS was assessed using three previously described indirect metrics for AECRS: the frequency of patient-reported sinus infections, CRS-related antibiotics use, and CRS-related oral corticosteroids use in the last 3 months. CRS symptom severity was measured using the 22-item Sinonasal Outcome Test (SNOT-22). Associations between ACT score and metrics for AECRS were performed using linear regression while controlling for clinical and demographic characteristics, including SNOT-22 score.

Results: ACT score was significantly and negatively associated with the frequency of patient-reported sinus infections (adjusted linear regression coefficient [β] = -1.2, 95% confidence interval [CI]: -2.3 to -0.1, P = .033), CRS-related antibiotics courses (adjusted β = -1.4, 95% CI: -2.3 to -0.5, P = .004), and CRS-related oral corticosteroid courses (adjusted β = -1.5, 95% CI: -2.5 to -0.5, P = .004) in the last 3 months, independent of characteristics including SNOT-22 score. Poor asthma control could be detected using one or more sinus infections (70.6% sensitivity, 47.3% specificity), CRS-related antibiotics (50.0% sensitivity, 73.0% specificity), or CRS-related oral corticosteroids (58.8% sensitivity, 71.6% specificity) in the last 3 months.

Conclusions: AECRS are negatively associated with the level of asthma control in asthmatic CRS patients, independent of CRS symptom severity. These results highlight AECRS as a distinct clinical manifestation of CRS that should be routinely assessed in CRS patients.

Level of evidence: 2c. Laryngoscope, 128:1033-1038, 2018.

Keywords: 22-item Sinonasal Outcome Test; Chronic rhinosinusitis; acute exacerbations; antibiotics; asthma control; oral corticosteroids.