AECRS Frequency Associated with Poorer Asthma Control in CRS

What is the relationship between the frequency of acute chronic rhinosinusitis (CRS) exacerbations (AECRS) and the degree of asthma control in asthmatic CRS patients?

Bottom Line
AECRS are negatively associated with the level of asthma control in asthmatic patients with CRS, independent of CRS symptom severity. These results highlight AECRS as a distinct clinical manifestation of CRS that should be routinely assessed in CRS patients.

Background: The natural history of CRS includes chronic nasal and extranasal symptoms as well as acute and transient increases in symptoms referred to as acute exacerbations of CRS (AECRS). One additional clinical manifestation of CRS is the exacerbation of comorbid pulmonary diseases, in particular asthma. The relationship between CRS and asthma is not only an epidemiological one, characterized by common comorbidity of these diseases, but also based on clinical and pathophysiologic commonalities as well. Like CRS, asthma is an inflammatory disease of the airway (albeit lower airway), whose natural history includes pulmonary and extra-pulmonary symptoms overlain with acute asthma exacerbations. Moreover, many of the cellular and molecular inflammatory mediators of asthma have also been identified as playing an important role in CRS.

Given the many shared features of CRS and asthma, it is not surprising that these diseases can impact each other’s disease course. Previous work has shown that comorbid CRS is associated with poorer asthma outcomes in general. The level of CRS symptom severity is negatively associated with the level of asthma control. Specifically, increasing CRS symptom severity is associated with poorer levels of asthma control. However, AECRS have been identified as clinical manifestations of CRS, whose impact on patients is distinct from the impact of chronic CRS symptomatology. It is therefore possible that the frequency of AECRS may be independently associated with decreased asthma control.

Study design: Cross-sectional study.

Setting: Department of Otolaryngology, Mass Eye and Ear Infirmary, Boston.

Synopsis: The authors prospectively recruited 108 asthmatic patients with CRS patients to participate. Asthma control was assessed using the Asthma Control Test (ACT). The frequency of AECRS was assessed using three previously described indirect metrics for AECRS: the frequency of patient-reported sinus infections, CRS-related antibiotics use, and CRS-related oral corticosteroids use in the last 3 months. CRS symptom severity was measured using the 22-item Sinonasal Outcome Test (SNOT-22). Associations between ACT score and metrics for AECRS were performed using linear regression while controlling for clinical and demographic characteristics, including SNOT-22 score. ACT score was significantly and negatively associated with the frequency of patient-reported sinus infections (adjusted linear regression coefficient [β] = −1.2, 95% confidence interval [CI]: −2.3 to −0.1, P = .033), CRS-related antibiotics courses (adjusted β = −1.4, 95% CI: −2.3 to −0.5, P = .004), and CRS-related oral corticosteroid courses (adjusted β = −1.5, 95% CI: −2.5 to −0.5, P = .004) in the last 3 months, independent of characteristics including SNOT-22 score. Poor asthma control could be detected using one or more sinus infections (70.6% sensitivity, 47.3% specificity), CRS-related antibiotics (50.0% sensitivity, 73.0% specificity), or CRS-related oral corticosteroids (58.8% sensitivity, 71.6% specificity) in the last three months.