Epidemiologic Factors and Surgical Outcomes in Patients with Nasal Polyposis and Asthma

Bush, Carrie M.; Jang, David W.; Champagne, Jason P.; Kountakis, Stilianos E.

doi:10.1159/000354804

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…Interestingly, the mean SNOT-20 scores for each of the 4 subgroups was higher in female patients than in males ( Table 2), indicating that females are more symptomatic overall. This is contrary to other studies [19,20] that have not demonstrated a gender difference in pre-treatment SNOT-20 scores, and is the first study to suggest that RS may impact the QoL differently in males and females.…”

Section: Discussioncontrasting

confidence: 99%

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Catalano¹

2015

OHNS

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Rhinosinusitis (RS) may be sub-classified into several groups based on duration of symptoms, etiology, associated clinical history, and findings during endoscopic nasal examination. While one may dissect RS into several subgroups, the four major clinical categories are Recurrent Acute Rhinosinusitis (RARS), Chronic Rhinosinusitis without Nasal Polyps (CRSsNP), Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), and Hyperplastic Rhinosinusitis (HRS). The American academy of Otolaryngology defines RARS as 4 or more acute infections per year of acute bacterial rhinosinusitis [1] lasting < 12 weeks. CRS is an inflammatory condition requiring the presence of 2 or more symptoms; one of which should be nasal discharge or nasal obstruction/blockage/congestion, +/-facial pain, +/-reduced or absent sense of smell, for 12 weeks or more. In addition, endoscopic findings or CT images showing pathological changes in the middle meat us should be present. CRS may exist with Nasal Polyps (CRSwNP) or without Nasal Polyps (CRSsNP). Extensive nasal polyposis may also be driven by allergic fungal sinusitis or by aspirin sensitivity in a subset of patients with asthma and nasal polyposis (Samter's triad) [2]. The latter two groups have been collectively referred to as Hyperplastic Rhinosinusitis (HRS) by Kennedy and Borish [3], and will be referred to as such for the purposes of this study. The economic healthcare burden of RS is estimated to be in the region of $5.8 billion annually, while the Quality of Life (QoL) impact of RS is just as significant [4]. Studies have identified lower QoL scores in CRS patients compared to those with congestive heart failure, chronic back pain, and chronic obstructive pulmonary disease [5]. Furthermore, CRSwNP patients were identified as having a lighter QoL burden than CRSsNP, excluding congestion as a symptom [6].

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Section: Discussioncontrasting

confidence: 99%

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Catalano¹

2015

OHNS

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“…These findings suggest that African-Americans, who are known to have higher prevalence and worse severity of asthma, also have worse CRSwNP than patients from other races (167). Pinto et al (168) reported that African-American CRS patients had lower vitamin D levels than control African-American patients, and Bush et al (169) reported that surgical outcomes were not as durable in African-American patients with polypoid CRS and asthma compared with Caucasian patients. Based on the foregoing, as well as information on asthma, it seems likely that CRSwNP is worse in African-Americans, Puerto Ricans, and Hispanics than in Caucasians and Asians, but clearly more studies are needed (164, 165).…”

Section: Race Eosinophilia and Crs: What Are The Roles Of Genes Andmentioning

confidence: 99%

Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis

Schleimer

2017

Annu. Rev. Pathol. Mech. Dis.

396

419

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Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that affects over 10% of the adult population, causing decreased quality of life, lost productivity, and lost time at work and leading to more than a million surgical interventions annually worldwide. The nose, paranasal sinuses, and associated lymphoid tissues play important roles in homeostasis and immunity, and CRS significantly impairs these normal functions. Pathogenic mechanisms of CRS have recently become the focus of intense investigations worldwide, and significant progress has been made. The two main forms of CRS that have been long recognized, with and without nasal polyps, are each now known to be heterogeneous, based on underlying mechanism, geographical location, and race. Loss of the immune barrier, including increased permeability of mucosal epithelium and reduced production of important antimicrobial substances and responses, is a common feature of many forms of CRS. One form of CRS with polyps found worldwide is driven by the cytokines IL-5 and IL-13 coming from Th2 cells, type 2 innate lymphoid cells, and probably mast cells. Type 2 cytokines activate inflammatory cells that are implicated in the pathogenic mechanism, including mast cells, basophils, and eosinophils. New classes of biological drugs that block the production or action of these cytokines are making important inroads toward new treatment paradigms in polypoid CRS.

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“…11 Whether this discrepancy is partially due to lower access to primary care or higher severity of disease in this group is unclear and merits further investigation. Bush et al 12 showed that both whites and AAs had a significant improvement in symptoms at 6 months after functional endoscopic sinus surgery, although AA subjects had an earlier relapse. Thus, determining the patient-related factors that result in increased health care utilization among AAs is an important public health concern.…”

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confidence: 99%

African American Patients with Chronic Rhinosinusitis Have a Distinct Phenotype of Polyposis Associated with Increased Asthma Hospitalization

Mahdavinia

Benhammuda

Codispoti

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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BACKGROUND Chronic rhinosinusitis (CRS) is a common inflammatory disease of the upper airways that is often categorized into subtypes including “with” and “without” nasal polyps. However, the influence of multiple important epidemiologic factors, including race, on CRS has not been investigated. OBJECTIVE The present study assessed various phenotypic characteristics of CRS in patients, living in the United States, with different racial backgrounds. METHODS We performed a large retrospective cohort study of patients with CRS treated at a large urban tertiary care referral center in Chicago. RESULTS African American (AA) patients with CRS living in Chicago were more likely to report hyposmia as a symptom of CRS. Furthermore, AA patients with CRS who failed medical therapy and required surgical intervention had a significantly higher frequency of nasal polyposis and aspirin-exacerbated respiratory disease, and a higher disease severity index on computed tomography imaging than did white patients with CRS. The increased polyposis in AAs was associated with increased hospitalization for asthma. There were no differences in the prevalence of atopy, asthma, atopic dermatitis, food allergy, duration of disease, or number of surgeries between different races. CONCLUSIONS AAs with refractory CRS are at increased risk for nasal polyposis, smell loss, aspirin-exacerbated respiratory disease, and a greater severity of disease based on imaging, resulting in increased health care utilization.

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Epidemiologic Factors and Surgical Outcomes in Patients with Nasal Polyposis and Asthma

Cited by 11 publications

References 20 publications

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Comparison of Quality of Life and Lund Mackay Score in Subgroups of Rhinosinusitis

Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis

African American Patients with Chronic Rhinosinusitis Have a Distinct Phenotype of Polyposis Associated with Increased Asthma Hospitalization

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