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. 2018 Jun;73(6):1244-1253.
doi: 10.1111/all.13409. Epub 2018 Feb 7.

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status

J R Kuiper  1 , A G Hirsch  2 , K Bandeen-Roche  3 , A S Sundaresan  2 , B K Tan  4   5 , R P Schleimer  4   5 , R C Kern  4   5 , W F Stewart  6 , B S Schwartz  1   2
Affiliations

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status

J R Kuiper et al. Allergy. 2018 Jun.

Abstract

Background: Nasal and sinus symptoms (NSS) are common to many health conditions, including chronic rhinosinusitis (CRS). Few studies have investigated the occurrence and severity of, and risk factors for, acute exacerbations of NSS (AENSS) by CRS status (current, past, or never met European Position Paper on Rhinosinusitis [EPOS] criteria for CRS).

Methods: Four seasonal questionnaires were mailed to a stratified random sample of Geisinger primary care patients. Logistic regression was used to identify individual characteristics associated with AENSS occurrence and severity by CRS status (current long-term, current recent, past, never) using EPOS subjective symptoms-only (EPOSS ) CRS criteria. We operationalized 3 AENSS definitions based on prescribed antibiotics or oral corticosteroids, symptoms, and symptoms with purulence.

Results: Baseline and at least 1 follow-up questionnaires were available from 4736 subjects. Self-reported NSS severity with exacerbation was worst in the current long-term CRS group. AENSS was common in all subgroups examined and generally more common among those with current EPOSS CRS. Seasonal prevalence of AENSS differed by AENSS definition and CRS status. Associations of risk factors with AENSS differed by definition, but CRS status, body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted AENSS.

Conclusions: In this first longitudinal, population-based study of 3 AENSS definitions, NSS and AENSS were both common, sometimes severe, and differed by EPOSS CRS status. Contrasting associations of risk factors for AENSS by the different definitions suggest a need for a standardized approach to definition of AENSS.

Keywords: chronic rhinosinusitis; epidemiology; exacerbation; longitudinal.

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Conflict of interest statement

Competing financial interests: The authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Mean nasal and sinus symptom severity score on a 10-point visual analogue scale, by EPOSS defined CRS status (current long-term, current recent, past, and never) and exacerbation definition. Nasal and sinus symptoms (NSS) severity in the past 4 weeks was ascertained by self-report at each follow-up questionnaire and estimated using survey-corrected methods. Three definitions of AENSS were operationalized: (A) AENSS-Med, (B) AENSS-Sx, and (C) AENSS-Sx-Pur. Non-overlapping confidence intervals indicate statistical significance (p < 0.05). Exact p-values of pairwise statistical associations are displayed in online supplemental material Table S3.
Figure 2
Figure 2
Population estimated prevalence of AENSS, by EPOSS defined CRS status (current long-term, current recent, past, and never), exacerbation definition, and season. Prevalence was estimated using survey-corrected methods. Three definitions of AENSS were operationalized: (A) AENSS-Med, (B) AENSS-Sx, and (C) AENSS-Sx-Pur.
See this image and copyright information in PMC

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