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Campbell RG, Auyeung T, Katsoulotos GP. Pulmonology for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:20-27. [PMID: 37997890 DOI: 10.1097/moo.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW The upper and lower airways are inter-related despite serving different functions and can no longer be considered separately. Rhinologists are becoming increasingly aware of the role the lower airway plays in optimizing outcomes for their patients. This review highlights recent developments in pulmonology that impact rhinologic conditions. RECENT FINDINGS The unified airway concept now supports the multidisciplinary management of respiratory and rhinologic pathologies. Biomarkers, biologics and the concept of treatable traits have permitted the development of personalized and precise treatment of the entire respiratory tract. The concept of corticosteroid stewardship, the introduction of steroid sparing agents for the treatment of respiratory diseases and the development of biomarkers, now forces us to be more considerate and precise with oral corticosteroid (OCS) prescribing and to consider reduction regimens. Finally, current research on climate change and vaping will allow us to better educate and prepare our patients to improve adherence and avoid exacerbations to maintain optimal global respiratory health. SUMMARY The inter-relatedness of the upper and lower airway has encouraged a multidisciplinary focus in respiratory medicine. More research is required to improve the precision respiratory medicine model, particularly in the realm of biomarkers and endotyping. These developments must also consider the impact of climate change, pollution and toxins for us to provide optimum care for our patients.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney
| | - Titus Auyeung
- Concord Clinical School, The University of Sydney, Sydney, NSW
| | - Gregory P Katsoulotos
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW
- The University of Notre Dame, Sydney, WA
- St Vincent's Clinic, Darlinghurst, NSW
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Zhang L, Li H, Wang T, Wang Z, Wu Y, Guo S, Li W, Zhou Y, Xue H, You J. Association between peripheral eosinophilia, JESREC score, and olfactory dysfunction in patients with chronic rhinosinusitis. Front Immunol 2024; 15:1334656. [PMID: 38327522 PMCID: PMC10847329 DOI: 10.3389/fimmu.2024.1334656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Objective The purpose was to evaluate the relationship between peripheral eosinophilia, Japan Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score, and olfactory dysfunction in chronic rhinosinusitis (CRS) patients and to explore the accuracy and specific cut points of the JESREC score in predicting olfactory dysfunction. Methods In this cross-sectional, retrospective study, olfactory function was assessed by the Sniffin' Sticks 12-item test and multivariate logistic regression analyses were carried out. Receiver operating characteristic curves were plotted to derive accuracy and cutoff values for the JESREC scores of the olfactory dysfunction criterion. Results A total of 354 patients [mean (SD) age, 50.0 (14.9) years; 41.8% women] were included in the final analysis. The prevalence of olfactory dysfunction was 46.3%. Individuals who had olfactory dysfunction were more likely to be male (64.6% vs. 52.6%), have eosinophilic chronic rhinosinusitis (ECRS) (39.0% vs. 7.9%), have a longer course of CRS (2.3 years vs. 1.5 years), have higher JESREC scores (8.5 vs. 4.5), and have higher proportions of nasal polyps (78.7% vs. 18.9%) and peripheral eosinophilia (3.3% vs. 1.4%). In logistic analysis, the percentage of eosinophils (1.25, 1.13-1.37), JESREC score (1.31, 1.22-1.40), bilateral lesion (2.06, 1.25-3.41), nasal polyps (15.83, 9.23-27.16), CT shadow (2.73, 1.69-4.43), and ECRS (6.86, 3.68-12.80) were associated with olfactory dysfunction in CRS patients after controlling for covariates, while peripheral neutrophils were not significant. In addition, the area under the curve was 0.778 and the cutoff value for JESREC score for olfactory dysfunction was defined as 5.5. Conclusions Peripheral eosinophilia and high JESREC scores were significantly associated with the risk of olfactory dysfunction in CRS patients, and special attention should be paid to patients with a JESREC score ≥6.
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Affiliation(s)
- Ling Zhang
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Haifeng Li
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Tao Wang
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Zhu Wang
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Yang Wu
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Siquan Guo
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Wenjing Li
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Yeru Zhou
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Haixiang Xue
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
| | - Jianqiang You
- Department of Otorhinolaryngology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China
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