Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis

Calabrese, Cecilia; Costigliola, Adriano; Maffei, Marianna; Simeon, Vittorio; Perna, Francesco; Tremante, Eugenio; Merola, Elena; Leone, Carlo Antonio; Bianco, Andrea

doi:10.2147/copd.s165857

Cited by 4 publications

(5 citation statements)

References 42 publications

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“…An observational study from 2018 treated a cohort of 49 COPD patients with 8 weeks of nasal budesonide. They found that not only did the UAS decline substantially, but COPD symptom burden score such as CAT score and dyspnoea score (mMRC) diminished as well [ 36 ]. This study however was neither randomised nor placebo-controlled.…”

Section: Discussionmentioning

confidence: 99%

Upper airway symptoms associate with the eosinophilic phenotype of COPD

et al. 2021

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BackgroundThere is growing evidence that upper airway symptoms coexist with lower airway symptoms in Chronic Obstructive Pulmonary Disease (COPD). Still, the prevalence and impact of upper airway disease on the nature and course of COPD remain unclear. We aimed to describe this in a cross-sectional study.MethodsWe examined a cohort of COPD patients with pulmonary function tests, induced sputum, blood eosinophils, atopy tests, CT of the paranasal sinuses. Lower airway symptoms were assessed using the COPD assessment test (CAT), and upper airway symptoms were assessed using the nasal subdomain of the 22-item Sino Nasal Outcome Test (SNOT22nasal). We recruited patients from five sites in Denmark and Sweden. We excluded patients with a history of asthma.FindingsIn total, 180 patients (female 55%, age 67 (±8) years, FEV1% 52.4 (±16.6), GOLD stage: A:18%, B:54%, C:3%, D:25%) were included in the study. Seventy-four patients (41%) reported high upper airway symptoms (high UAS defined as SNOT22nasal≥6) with a median score of 10 (IQR 8–13). Patients with high UAS reported higher CAT scores (17.4 (±7.5) versus 14.9 ±6.6, p<0.05) and displayed higher fractions of eosinophils in blood (median 3.0% (IQR 1.6–4.2%) versus 2.3% (IQR 1.4–3.1), p<0.05) and in induced sputum (median 1.8% (IQR 0.3–7.1%) versus median 0.5% (IQR 0–1.7%), p<0.05). No differences in atopy, CT findings or exacerbation rates were observed.ConclusionCOPD patients with upper airway disease showed increased evidence of eosinophilic disease and increased lower airway symptom burden.

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Section: Discussionmentioning

confidence: 99%

Upper airway symptoms associate with the eosinophilic phenotype of COPD

et al. 2021

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“…The latter has been reported to be the strongest predictor of all-cause mortality in a prospective cohort study of COPD patients. 45 Improvement in the grade of dyspnea after 8 weeks of nasal corticosteroid therapy in a pilot study of COPD patients 42 is a promising result that requires confirmation in a larger study.…”

Section: Discussionmentioning

confidence: 99%

“… 41 Moreover, nasal symptoms (SNOT items 1–8), degree of dyspnea (mMRC) and HRQoL (CAT score) were significantly improved after 8 weeks of daily anti-inflammatory treatment with nasal budesonide in a recent clinical trial in stable COPD patients. 42 Thus, clinicians should be aware of the high prevalence of sinonasal symptoms in COPD, and enquiry about their presence in these patients should be a routine in clinical practice. Early recognition and treatment of sinonasal symptoms may contribute to optimising the management of COPD.…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

Øie¹,

Helvik²,

Sue‐Chu³

et al. 2022

COPD

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Purpose Sinonasal symptoms are prevalent in COPD, and knowledge of the relationship between these symptoms and clinical markers of COPD is limited. This study explores the associations between the burden of sinonasal symptoms and clinical markers and thresholds recommended for guiding treatment decisions in the GOLD guidelines. Patients and Methods Sinonasal symptoms were quantified with the rhinological subscale of the Sino-Nasal-Outcome-Test (SNOT-22) in 93 COPD patients characterized by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 diagnostic criteria for rhinosinusitis without nasal polyps (RSsNP). Associations between a high burden, defined as a SNOT22_rhinological score of ≥11, and the following markers were assessed by adjusted multivariable linear regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough [Visual Analogue Scale (VAS)], physical activity [6-minute walking distance (6MWD)], mortality risk (BODE index), and HRQoL [disease-specific COPD Assessment Test (CAT) and St. Georges Respiratory Questionnaire (SGRQ), and physical component summary, Short Form-36 version 2.0 (PCS SF-36v2)]. Odds ratios for the association of a high burden and threshold levels for regular treatment were estimated by adjusted binomial logistic regression models. Results A high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher BODE index and poorer HRQoL. The odds ratio of having CAT and SGRQ scores that are above the thresholds recommended for treatment was 5–7-fold greater in the high burden group. Conclusion A high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity and mortality risk and is inversely associated with physical activity and HRQoL in COPD. These findings add further support that the UAD concept also applies to COPD. Enquiry about sinonasal symptoms in COPD patients should be incorporated into the clinical routine.

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“…Intranasal administration of ICS improves nasal symptoms score but also the COPD assessment test score and decreases dyspnea, quantified according to the modified Medical Research Council (mMRC) scale (83).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

et al. 2021

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The large amount of evidence and the renewed interest on upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma excecutive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change.UAD refer to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan.The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and homebased continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD.Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.

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Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis

Cited by 4 publications

References 42 publications

Upper airway symptoms associate with the eosinophilic phenotype of COPD

Upper airway symptoms associate with the eosinophilic phenotype of COPD

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

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