The prevalence and effect of asthma on adults with chronic rhinosinusitis

Ear, Nose & Throat Journal, July, 2007 by Melanie W. Seybt, Kevin C. McMains, E. Stilianos Kountakis

Abstract

We conducted a retrospective review of 145 consecutively presenting adults treated for chronic rhinosinusitis (CRS) in a tertiary care institution. Our goals were to determine (1) the prevalence of asthma in these patients, (2) the prevalence of specific CRS symptoms in both asthmatic and nonasthmatic patients, and (3) the frequency of surgical treatment for CRS in patients with and without asthma. We found that asthma was present in 23.4% of CRS patients, a much higher rate than the 5% prevalence of asthma in the general adult population. Patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%; p = 0.027) than did those without asthma. Patients without asthma had a significantly higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38%; p = 0.047). The prevalence of postnasal drip and environmental allergies in the two groups was similar. Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003).

Introduction

The association between asthma and chronic rhinosinusitis (CRS) has long been established. Although the exact nature of this relationship has not yet been elucidated, molecular research is focusing on the notion that asthma and CRS likely represent upper- and lower-airway manifestations of the same mucosal inflammation. (1) Such an association may indicate that the ciliated, pseudostratified, columnar respiratory epithelia that line the lungs, nose, and sinuses may share a common pathophysiology.(2)

In general, sinusitis in patients with asthma tends to be more severe and refractory to conventional medical management than it is in patients without asthma. (3) In this article, we describe the results of our study of the prevalence of asthma in CRS patients, the prevalence of specific CRS symptoms in patients with and without asthma, and differences between the two groups with respect to the need for sinus surgery.

Patients and methods

We retrospectively reviewed the charts of 145 consecutively presenting eligible patients---64 men and 81 women, aged 18 to 83 years (mean: 46.1)--who had been diagnosed with CRS at the Medical College of Georgia's rhinology clinic from January through September 2003. Data were compiled by a manual chart review, and a database was created to record each patient's demographic information, the presence or absence of asthma, and the presence or absence of six specific signs and symptoms: nasal polyps, olfactory dysfunction (anosmia/hyposmia), nasal congestion, headache, rhinorrhea, and postnasal drip. Other variables evaluated included the presence of environmental allergies (based on history, medication use, and physical examination findings) and the need for surgical management.

Patients were designated as asthmatic if (1) they had a history of asthma, (2) if they had a history of positive pulmonary function test results, and/or (3) if they were taking an asthma medication at the time of presentation. Before patients were considered for surgery, they underwent medical therapy with intranasal steroids, saline nasal sprays and irrigations, high-dose guaifenesin, and/or appropriate antibiotic therapy when indicated. The diagnosis of sinusitis was based on criteria set forth by the Task Force on Rhinosinusitis. (4)

Patients with cystic fibrosis, immunodeficiency disorders, a history of facial trauma, or a neoplastic process were not eligible for this study. The study was approved by our institutional review board.

Results

Of the 145 patients with CRS, 34 (23.4%) were being treated concurrently for asthma and 111 (76.6%) were not.

The patients with asthma had a significantly higher prevalence of nasal polyps (47 vs. 22%; p = 0.004), olfactory dysfunction (26 vs. 6%; p = 0.001), and nasal congestion (85 vs. 60%;p = 0.027) (figure 1). The patients without asthma had a higher prevalence of headache (72 vs. 53%; p = 0.037) and rhinorrhea (58 vs. 38% ;p = 0.047). The prevalence of postnasal drip was similar in the two groups (29% for those with asthma and 31% for those without; p = 0.892).

[FIGURE 1 OMITTED]

The prevalence of environmental allergies was similar in the two groups. Although the difference between the proportions of patients with and without asthma who required primary sinus surgery was not statistically significant (76 vs. 64%; p = 0.175), individual patients with asthma did require significantly more revision sinus procedures overall (mean: 2.9 vs. 1.5; p = 0.003) (figure 2).

[FIGURE 2 OMITTED]

Discussion

Multiple theories have been proposed to explain the association between asthma and CRS. According to one early theory, sinus material is aspirated into the lower airways, where it irritates the epithelium and exacerbates the asthma. (5) However, Bardin et al argued that this seeding effect is a very unlikely cause of asthma; they administered experimental radionuclide to the sinuses of patients with sinusitis and asthma and found no evidence that the radionuclide was aspirated into the lungs. (6)