How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings

Abstract

In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.

Association of chronic rhinosinusitis with nasal polyps and asthma: Clinical and radiological features, allergy and inflammation markers

“…As we studied the patients referred to tertiary university center, they consisted a group of patients with nasal symptoms lasting more than a decade, who had high sinus CT score, were treated surgically repeatedly for their sinus disease, and can be characterized as having symptoms of severe CRS. Our results agree with the previous data that olfactory impairment is common in patients with CRS, although a complete olfactory loss was a characteristic feature of NPs (7,30). History of aspirin intolerance is one of diseaseaggravating factor leading to nasal polyps and more associated with asthma (8,31).…”

Criteria To Screen for Chronic Sinonasal Disease

“…Imaging, either by CT scanning or endoscopy, are frequently used as "gold standards," though they give complementary information and are not always in agreement. 6,26 Our questionnaire is unique in that we have chosen to diagnose chronic sinonasal disease rather than to focus specifically on rhinitis and sinusitis, as these diseases represent a continuum, particularly in patients with asthma. Because there is no "gold standard" for the diagnosis of chronic sinonasal disease, we chose to incorporate symptoms, and CT scan and endoscopic findings into our evaluation, and to submit these findings to an expert panel.…”

“…Based on previous reports in the literature, 6,7 we identified 6 questions from the original total of 13 questions that were related to the frequency of specific symptoms, and that we hypothesized would be both sensitive and specific for identifying patients with sinonasal disease. We tested the performance characteristics of these items and compared them with other standard questionnaires and specific testing procedures.…”

“…The data set included multiple questions pertaining to specific sinonasal symptoms (13 total, shown in the online supplement) that have been reported in the literature, 6,7 were believed to be relevant by the expert panel, and would be useful and relevant in a clinical setting. In addition to the answers to these questions, the data set included the results of a previously published sinus symptom scale score, 10 and the endoscopy and CT scanning.…”

Assessment of problematic severe asthma in children: Figure 1–

“…However, upper airway evaluation, including anterior rhinoscopy when appropriate, should be part of the assessment of problematic severe asthma. Additional tests including sinus computed tomography (CT) or magnetic resonance imaging, which are more informative than plain sinus radiography studies in children, should be considered [52,53]. Sinusitis has been reported in a high proportion of children with severe asthma [54] with or without nasal symptoms, and a relationship between abnormalities on sinus CT and bronchial eosinophilic inflammation has been shown in adults [55,56].…”