Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 11:20:273-286.
doi: 10.2147/COPD.S493219. eCollection 2025.

Chronic Airflow Limitation, Lower Respiratory Symptoms, COPD and Chronic Rhinosinusitis in a Middle-Aged Population: The Swedish CArdioPulmonary bioImage Study (SCAPIS). A Link Between the Lower and Upper Airways

Anders Andersson #  1   2 , Joel Bergqvist #  3   4 , Linus Schiöler  5 , Apostolos Bossios  6   7 , Lovisa Farnebo  8   9 , Thorbjörn Holmlund  10 , Christer Janson  11 , Sumru Keceli  12 , Mirjam Ljunggren  11 , Andrei Malinovschi  13 , Ensieh Memarian  14 , Ulf Nihlén  15 , Peter M Nilsson  16   17 , Ida Pesonen  18   19 , Marcus Sjöström  10 , Nikolai Stenfors  20 , Fredrik Sundbom  11 , Mimmi Werner  10 , Kjell Torén  5   21 , Magnus Sköld  22   23 , Johan Hellgren  24   25
Affiliations

Chronic Airflow Limitation, Lower Respiratory Symptoms, COPD and Chronic Rhinosinusitis in a Middle-Aged Population: The Swedish CArdioPulmonary bioImage Study (SCAPIS). A Link Between the Lower and Upper Airways

Anders Andersson et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Chronic rhinosinusitis (CRS) is related to asthma and chronic obstructive pulmonary disease (COPD). However, combined data on CRS, pulmonary function, lower airway symptoms, and cigarette smoking from the general population are lacking. The current study investigates the relationships between CRS and chronic airflow limitation (CAL), lower airway symptoms and COPD in a middle-aged population of ever-smokers and never-smokers.

Patients and methods: All subjects from the Swedish CArdioPulmonary bioImage Study (SCAPIS) were included. Subjects underwent spirometry after bronchodilation. Chronic airflow limitation was defined as FEV1/FVC ratio <0.7. Computed tomography imaging of the thorax was performed to detect the presence of emphysema, and the subjects answered a comprehensive questionnaire on CRS, lower airway symptoms, asthma, chronic bronchitis, and cigarette smoking habits.

Results: In total, 30,154 adult subjects in the age range of 50-64 years were included. The prevalence of CRS was 5.6%. CRS was more-prevalent among subjects in the following categories: CAL (7.6%), lower airway symptoms (15.7%), current smokers (8.2%), asthma (13.6%), never-smokers and ever-smokers with COPD (17.6% and 15.3%, respectively), emphysema (6.7%), and chronic bronchitis (24.5%). In the adjusted regression model, CRS was significantly associated with CAL (OR 1.40), lower airway symptoms (OR 4.59), chronic bronchitis (OR 6.48), asthma (OR 3.08), and COPD (OR 3.10).

Conclusion: In this national, randomly chosen population sample of more than 30,000 middle-aged men and women, CRS is associated with CAL, lower airway symptoms, chronic bronchitis, asthma, and COPD. In patients with CRS and in patients with lower airway inflammation, it is important to consider the inflammatory status of the entire airway system.

Keywords: CRS; asthma; chronic bronchitis; chronic obstructive pulmonary disease; emphysema; smoking.

PubMed Disclaimer

Conflict of interest statement

Dr Anders Andersson reports personal fees from Astra-Zeneca, Chiesi, and TEVA, outside the submitted work. Dr Apostolos Bossios reports grants paid to institution from AstraZeneca, Chiesi, and GSK, outside the submitted work; and Head of Assembly 5 (Airway diseases, asthma, COPD, and chronic cough), European Respiratory Society; co-chair of the Nordic severe asthma network; member of the steering committee of SHARP, ERS severe asthma Clinical Research Collaboration; member of the steering committee of the Swedish National Airway Register. Professor Magnus Sköld reports grants from Pharmaceutical companies paid to his institution for consultancy, outside the submitted work. The authors declare that they have no other competing interests in this work.

Figures

Figure 1
Figure 1
Odds ratio for CRS in the relation to the quota of FEV1/FVC. Adjusted Odds ratios (ORs) including 95% CI (the shaded blue area) from the multivariable logistic regression model for chronic rhinosinusitis (CRS) in relation to different ratios of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC). The model is adjusted for sex, age, BMI, pack-years and cigarette smoking. FEV1/FVC as cubic restricted spline with overall p=0.001.
Figure 2
Figure 2
(A and B) Odds ratio for having CRS in relation to lower airway diseases and symptoms. Multivariable logistic regression model of Odds ratio (OR) and 95% CI for chronic rhinosinusitis (CRS) in relation to chronic airflow limitation (CAL), emphysema, lower airway symptoms (cough, wheeze or dyspnea), chronic bronchitis, asthma and COPD in six individual models adjusted for age, sex, BMI and cigarette smoking. COPD was defined as having CAL and at least one lower airway symptom, irrespective of cigarette smoking status. The whole study population is shown (A) and divided into men and women (B).
Figure 3
Figure 3
Number of lower airway symptoms in relation to the Odds ratio of having CRS. Logistic regression model of the Odds ratio (OR) and 95% CI for chronic rhinosinusitis (CRS) in relation to the number of reported lower airway symptoms (cough, wheeze, dyspnea = mMRC≥2), adjusted for age, sex, BMI, and cigarette smoking status.
Figure 4
Figure 4
Level of mMRC in relation to Odds ratio of having CRS. Logistic regression model of the Odds ratio (OR) with 95% CI of chronic rhinosinusitis (CRS) in relation to the symptom dyspnea defined as mMRC 0–4. Model is adjusted for age, sex, BMI, asthma and cigarette smoking status.
See this image and copyright information in PMC

References

    1. Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA(2)LEN study. Allergy. 2011;66(9):1216–1223. doi:10.1111/j.1398-9995.2011.02646.x - DOI - PubMed
    1. Hirsch AG, Stewart WF, Sundaresan AS, et al. Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample. Allergy. 2017;72(2):274–281. doi:10.1111/all.13042 - DOI - PMC - PubMed
    1. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1–464. doi:10.4193/Rhin20.401 - DOI - PubMed
    1. Tomassen P, Newson RB, Hoffmans R, et al. Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis--a GA(2) LEN study. Allergy. 2011;66(4):556–561. doi:10.1111/j.1398-9995.2010.02503.x - DOI - PubMed
    1. Khan A, Vandeplas G, Huynh TMT, et al. The Global Allergy and Asthma European Network (GALEN rhinosinusitis cohort: a large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps. Rhinology. 2019;57(1):32–42. doi:10.4193/Rhin17.255 - DOI - PubMed

Publication types

MeSH terms