Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population

Abstract

Background Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics. Methods At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses. Results A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p =0.011) and oral steroid courses for CRS (p = 0.003). Conclusion While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.

Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials

“…Patients with asthma are more likely to develop CRSwNP than are those without asthma, and they are more likely to have severe disease, receive more oral corticosteroid courses, and experience relapse requiring multiple endoscopic surgeries. 3,35 In the pooled population, most patients with comorbid asthma had physicianassessed mild to moderate disease (93.4%). Nonetheless, improvements in AQLQ score were similar to a previous study in a population with more severe asthma.…”

Asthma and Chronic Rhinosinusitis: Diagnosis and Medical Management

“…A similar cluster analysis by SARP identified four phenotypic clusters in children that differed primarily according to asthma duration, the number of asthma controller medications being used, and lung function [51]. Of these clusters, late-onset asthmatics had higher frequency of sinusitis, more severe sinus disease radiographically, and higher rates of sinus surgery [52,53,54]. Accordingly, it is crucial in these patients to assess for cardinal symptoms associated with CRS, including nasal obstruction, discolored nasal discharge, facial pain or pressure, loss of sense of smell, and cough (in children) that persists for greater than 12 weeks [55,56].…”

The evolving algorithm of biological selection in severe asthma

“…In 437 patients included in the Severe Asthma Network in Italy (SANI), 64% were taking chronic OCSs, 42.6% had CRSwNP, and 9.6% had atopic eczema . A sub‐analysis of data from SANI showed that among patients with early‐onset asthma, 41% had CRSwNP, while among those with late‐onset asthma, 61% had CRSwNP, had taken three courses of OCS in the previous year for sinus symptoms, and reported two sinus surgeries in their lifetime . Reducing OCS use is clearly an important outcome for patients and the payer.…”