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. 2021 Aug;9(8):3188-3195.e2.
doi: 10.1016/j.jaip.2021.04.054. Epub 2021 May 24.

Prevalence of Bronchiectasis in Patients with Chronic Rhinosinusitis in a Tertiary Care Center

Anju T Peters  1 , Sumit Bose  2 , Amina Guo  2 , Newton Li  2 , Mariel Benjamin  2 , Michelle Prickett  3 , Raul S Villareal  2 , Amy Yang  4 , Atsushi Kato  2 , Robert C Kern  5 , Bruce K Tan  5 , Leslie C Grammer  2 , Robert P Schleimer  5 , David B Conley  6 , Stephanie S Smith  6 , Kevin C Welch  6 , Whitney W Stevens  5
Affiliations

Prevalence of Bronchiectasis in Patients with Chronic Rhinosinusitis in a Tertiary Care Center

Anju T Peters et al. J Allergy Clin Immunol Pract. 2021 Aug.

Abstract

Background: Whereas chronic rhinosinusitis (CRS) is associated with asthma, and vice versa, the association between CRS and other lower respiratory conditions is not well-established. Bronchiectasis is characterized by permanent damage of the airways, and as many as 45% of bronchiectasis patients have CRS, but the prevalence of bronchiectasis among CRS patients is not known.

Objective: To determine the prevalence of bronchiectasis among CRS patients and to characterize demographic and clinical features of patients with bronchiectasis and CRS.

Methods: Electronic medical records of patients with rhinosinusitis were searched by computer algorithm supplemented with manual chart review to identify patients with CRS, asthma, and/or bronchiectasis. Demographic and clinical features and antibiotic courses for sinopulmonary infections 2 years before and after sinus surgery were obtained by manual chart review.

Results: The prevalence of bronchiectasis as determined by International Classification of Diseases, Ninth Revision code was significantly higher in CRS patients than in asthmatic patients (2.3% vs 1.7%; P < .003). Similarly, based on a text word search of "bronchiectasis" in the chest computed tomography (CT) scan reports, patients with CRS who had chest CT scans had a higher prevalence of bronchiectasis than did asthmatic patients with chest CT scans (24.3% vs 19.5%; P = .005). Patients with CRS and concurrent bronchiectasis did not have a reduction in the frequency of sinopulmonary infections after sinus surgery compared with patients with CRS without bronchiectasis (P < .05).

Conclusions: Bronchiectasis is an important comorbidity in patients with CRS and may identify a severe phenotype of chronic sinonasal disease.

Keywords: Antibiotics; Asthma; Bronchiectasis; CRSsNP; CRSwNP; Chronic rhinosinusitis; Nasal polyp; Prevalence.

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Conflict of interest statement

A.T. Peters has served as an advisor to Sanofi, AstraZeneca, GSK, and Optinose. R.P. Schleimer reports grants from NIH during the conduct of the study; and reports personal fees, equity or both from serving as a consultant for Intersect ENT, GlaxoSmithKline, Allakos, Aurasense, Merck, BioMarck, Sanofi, AstraZeneca/Medimmune, Genentech, Exicure Inc, Otsuka Inc, Aqualung Therapeutics Corp, and ActoBio Therapeutics, outside the submitted work. In addition, R.P. Schleimer has Siglec-8 and Siglec-8 ligand related patents licensed to Allakos Inc. W.W. Stevens has served as an advisor to GlaxoSmithKline, Bristol Myers Squibb, and Genentech. The rest of the authors declare they have no relevant conflict of interests.

Figures

Figure 1.
Figure 1.. Algorithm for determining the prevalence of bronchiectasis in patients with CRS and asthma using radiographic or ICD-9 code based strategies.
□ 76 patients with bronchiectasis identified by ICD-9 code strategy overlapped in the CRS and asthma groups. ⌘ 153 patients with bronchiectasis identified by text word search in the chest CT scan report overlapped in the CRS and asthma groups. 2,171 patients without bronchiectasis overlapped in the CRS and asthma groups.
Figure 2.
Figure 2.
Algorithm for identifying clinically relevant bronchiectasis in patients with CRSsNP and with CRSwNP by manual chart review.
Figure 3.
Figure 3.. Prevalence of bronchiectasis is higher in patients with CRS than in patients with asthma.
The prevalence of bronchiectasis was determined by ICD-9 code (A) or by text word search of “bronchiectasis” in chest CT scan reports in those with chest CT scans (B) in patients with CRS and with asthma. Using either strategy, CRS patients had a significantly higher prevalence of bronchiectasis than asthmatics. The prevalence of bronchiectasis was determined by manual chart review in subgroups of patients with CRS who had chest CT scans (C). The percentage in each column represents the percentage of patients with bronchiectasis while the number in each column indicates how many patients had bronchiectasis compared to the total number of patients in each condition. Statistical significance was determined by Chi-square test.
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