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Wautlet A, Bachert C, Desrosiers M, Hellings PW, Peters AT. The Management of Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) With Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2642-2651. [PMID: 37182568 DOI: 10.1016/j.jaip.2023.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
Chronic rhinosinusitis with nasal polyps affects a significant portion of the worldwide population. This illness is associated with several chronic conditions and has an important impact on patient quality of life, leading to a great societal economic burden. In recent years, biologic medications have been developed and found to be effective in the treatment of chronic rhinosinusitis with nasal polyps. This review focuses on these treatment options and their ability to improve patient outcomes, including quality of life. It also reviews available evidence with regards to patient selection, monitoring of patients after treatment initiation, and comparison of different biologics and with other treatment options such as sinus surgery.
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Affiliation(s)
- A Wautlet
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - C Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Munster, Munster, Germany; Department of Otorhinolaryngology, First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China; Upper Airways Research Laboratory, Department of Otorhinolaryngology, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - M Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium; Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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Lee KI, Han Y, Ryu JS, In SM, Kim JY, Park JS, Kim JS, Kim J, Youn J, Park SR. Tobacco Smoking Could Accentuate Epithelial-Mesenchymal Transition and Th2-Type Response in Patients With Chronic Rhinosinusitis With Nasal Polyps. Immune Netw 2022; 22:e35. [PMID: 36081523 PMCID: PMC9433194 DOI: 10.4110/in.2022.22.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022] Open
Abstract
Tobacco smoking (TS) has been known as one of the most potent risk factors for airway inflammatory diseases. However, there has been a paucity of information regarding the immunologic alteration mediated by TS in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). To identify the effect of TS, we harvested human tissue samples (never smoker: n=41, current smoker: n=22, quitter: n=23) and analyzed the expression of epithelial-derived cytokines (EDCs) such as IL-25, IL-33, and thymic stromal lymphopoietin. The expressions of Th2 cytokines and total serum IgE showed a type-2 inflammatory alteration by TS. In addition, the epithelial marker E-cadherin and epithelial-mesenchymal transition (EMT)-associated markers (N-cadherin, α-SMA, and vimentin) were evaluated. Histological analysis showed that EDC expressions were upregulated in the current smoker group and downregulated in the quitter group. These expression patterns were consistent with mRNA and protein expression levels. We also found that the local Th2 cytokine expression and IgE class switching, as well as serum IgE levels, were elevated in the current smoker group and showed normal levels in the quitter group. Furthermore, the expressions of E-cadherin decreased while those of N-cadherin, α-SMA, and vimentin increased in the current smoker group compared those in the never smoker group. Taken together, these results indicate that TS contributes to the deterioration of pathogenesis by releasing local EDCs and Th2 cytokines, resulting in EMT in patients with CRSwNP. We verified that alterations of immunological response by TS in sinonasal epithelium can play a vital role in leading to CRSwNP.
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Affiliation(s)
- Ki-Il Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon 35365, Korea
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Younghwan Han
- Priority Research Center, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Jae-Sung Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon 35365, Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Seung Min In
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon 35365, Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Joong Su Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Jong-Seok Kim
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Juhye Kim
- Department of Medicine, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Jubin Youn
- Department of Medicine, College of Medicine, Konyang University, Daejeon 35365, Korea
| | - Seok-Rae Park
- Priority Research Center, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon 35365, Korea
- Department of Microbiology, College of Medicine, Konyang University, Daejeon 35365, Korea
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Talat R, Gengler I, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Chronic Rhinosinusitis Outcomes of Patients With Aspirin-Exacerbated Respiratory Disease Treated With Budesonide Irrigations: A Case Series. Ann Otol Rhinol Laryngol 2021; 131:1130-1136. [PMID: 34775833 DOI: 10.1177/00034894211054948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathophysiology-targeting treatments exist for aspirin-exacerbated respiratory disease (AERD) through aspirin desensitization and biologics, such as dupilumab. With increasing attention paid to these treatments, which may be associated with significant side effects and/or cost, there is little description of chronic rhinosinusitis with nasal polyps (CRSwNP) response to treatment with intranasal corticosteroids and saline irrigations in AERD. OBJECTIVE To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD. METHODS This is an observational study of 14 AERD patients presenting to a rhinology clinic for CRS who were treated with twice daily high volume, low pressure irrigations with 240 mL of saline to which a 0.5 mg/2 mL respule of budesonide was added. All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) at enrollment and at follow up 1 to 6 months later. Polyp scores were also calculated at each time point. RESULTS SNOT-22 scores ranged from 26 to 98 (median: 40.5) at enrollment and 3 to 85 (median: 38.5) at follow-up. Polyp scores ranged from 2 to 6 (median: 4) at enrollment at 0 to 6 (median: 2) at follow-up. Over the treatment period, change in SNOT-22 score ranged from -38 to 16 (median: -18) and change in polyp score ranged from -2 to 0 (median: -0.5). Approximately 57% of participants experienced at least 1 minimal clinically important difference in SNOT-22 score and 21% of participants had a SNOT-22 score <20 at follow-up. CONCLUSION Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD.
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Affiliation(s)
- Rehab Talat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Boston, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Gengler I, Kavoosi TA, McCann AC, Trope M, Lindsey BA, Speth MM, Sassler AM, Seiden AM, Phillips KM, Sedaghat AR. Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: A pilot study. Clin Otolaryngol 2021; 46:1021-1027. [PMID: 33780598 DOI: 10.1111/coa.13774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) for assessment of chronic rhinosinusitis (CRS) employ a variety of recall periods and response scales for reporting CRS symptom burden. CRS patient perspective is unknown with respect to recall periods and response scales in PROMs. DESIGN Cross-sectional study. SETTING Tertiary rhinology clinic. PARTICIPANTS Sixty three adults with CRS. MAIN OUTCOME MEASURES Participants were asked to choose which CRS symptom recall period-1 day, 2 weeks, 1 month or greater than 1 month-was most reflective of their current disease state and best to base treatment recommendations (including surgery) upon. Participants were also asked to report which of six response scales (one visual analogue scale [VAS] and five Likert scales ranging from four to eight items) were easiest to use and understand, and most preferred. RESULTS A majority of participants felt the current state of their CRS symptoms was best reflected by a recall period of 2 weeks to 1 month; however, patients preferred that recommendations about treatments, including endoscopic sinus surgery, be determined by symptoms experienced over at least a one-month period. Participants generally found the VAS and seven-item Likert scale to be the easiest to use and understand, and their most preferred scales. No patient characteristics associated with preferences for recall periods or response scales. CONCLUSION Future PROMs for CRS symptoms should consider assessment of symptoms over a one-month time frame and use either a VAS or seven-item Likert response scale to optimally balance reflection of current disease state, need for intervention and patient preference.
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Affiliation(s)
- Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tazheh A Kavoosi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michal Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brentley A Lindsey
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marlene M Speth
- Klinik für Hals-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Alfred M Sassler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allen M Seiden
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Epperson MV, McCann AC, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Unbiased Measure of General Quality of Life in Chronic Rhinosinusitis Reveals Disease Modifiers. Laryngoscope 2020; 131:1206-1211. [PMID: 33006402 DOI: 10.1002/lary.29139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/22/2020] [Accepted: 09/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is associated with a significant decrease in general health-related quality of life (QOL). The EuroQol 5-dimensional questionnaire measures general health-related quality of life through a health utility value (EQ-5D HUV)-based on five domains reflecting mobility, self-care, activities of daily life, pain/discomfort, and anxiety/depression-and an unbiased visual analog scale (EQ-5D VAS). We sought to identify characteristics of CRS patients with a high EQ-5D HUV but low EQ-5D VAS score. MATERIALS AND METHODS Retrospective cross-sectional study of 300 CRS patients with EQ-5D HUV equal to 1.0 (reflecting perfect health). All patients completed a 22-item Sinonasal Outcome Test (SNOT-22)-from which nasal, sleep, ear/facial discomfort, and emotional subdomain scores were calculated, as well as the EQ-5D. Low EQ-5D VAS was defined as a score less than 80. RESULTS On multivariate analysis, low EQ-5D VAS was associated with only the SNOT-22 sleep subdomain score (odds ratio [OR] = 1.07, 95%CI: 1.02-1.12, P = .003). Comorbid asthma was also associated with lower EQ-5D VAS (OR = 2.16, 95%CI: 1.02-4.59, P = .045). In contrast, polyps were negatively associated with having a lower EQ-5D VAS (OR = 0.34, 95%CI: 0.17-0.69, P = .003). CONCLUSION There are patients with perfect general health-related QOL according to a health utility value-based methodology (like the EQ-5D HUV) who report low general health-related QOL on an unbiased measure like the EQ-5D VAS. In CRS patients with perfect EQ-5D HUV, poor sleep and asthma were associated with low QOL on the EQ-5D VAS, while polyps were negatively associated with low QOL. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1206-1211, 2021.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Cheng J, Chen J, Zhao Y, Yang J, Xue K, Wang Z. MicroRNA-761 suppresses remodeling of nasal mucosa and epithelial-mesenchymal transition in mice with chronic rhinosinusitis through LCN2. Stem Cell Res Ther 2020; 11:151. [PMID: 32272958 PMCID: PMC7147028 DOI: 10.1186/s13287-020-01598-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) is characterized by persistent symptomatic inflammation of the nasal passage and sinus mucosa. Various microRNAs (miRs) have been implicated in CRS. Hence, the current study was conducted to explore the effect of microRNA-761 (miR-761) on remodeling of nasal mucosa and epithelial–mesenchymal transition (EMT). Methods Bioinformatics analysis was initially performed to predict the differentially expressed genes (DEGs) associated with CRS. Gene targeting relationship between miR-761 and lipocalin 2 (LCN2) was analyzed by bioinformatics analysis and verified using dual-luciferase reporter gene assay. Histopathological analyses of the nasal mucosa tissues were conducted via hematoxylin–eosin (HE) and alcian blue (AB)-periodic acid Schiff (PAS) staining. ELISA was employed to determine the IL-8 and MMP-9 levels. To define downstream pathway of miR-761, levels of proteins related to LCN2/Twist1 signaling pathway were assessed. Additionally, the effects of miR-761 on EMT, proliferation, and apoptosis were determined. Results LCN2 was highly expressed in CRS. LCN2 was a target of miR-761. miR-761 overexpression or LCN2 silencing decreased IL-8 and MMP-9 levels and morphological changes in nasal epithelial tissue from CRS mice. Overexpressed miR-761 or silenced LCN2 decreased the expression of LCN2 and Twist1, indicating LCN2/Twist1 signaling pathway was inactivated. Moreover, miR-761 overexpression or LCN2 silencing reduced the expression of N-cadherin and vimentin, while increased that of E-cadherin, suggesting inhibition of EMT. Furthermore, miR-761 overexpression or LCN2 silencing promoted cell proliferation and inhibited cell apoptosis in CRS. Conclusion Taken together, miR-761 suppressed the remodeling of nasal mucosa through inhibition of LCN2 and the LCN2/Twist1 signaling pathway.
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Affiliation(s)
- Jinzhang Cheng
- Department of Otolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Junjun Chen
- Department of Pharmacy, the Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Yin Zhao
- Department of Otolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Jingpu Yang
- Department of Otolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Kai Xue
- Department of Otolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Zonggui Wang
- Department of Otolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China.
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Epperson MV, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Predictors of efficacy for combination oral and topical corticosteroids to treat patients with chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2019; 9:1436-1442. [PMID: 31609091 DOI: 10.1002/alr.22431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND A short-course oral corticosteroid taper and topical intranasal corticosteroids may be used to maximize the success of medical management for chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to identify characteristics that would be predictive of efficacy for this combination regimen. METHODS Sixty-four patients with CRS, bilateral polyps, a polyp score of at least 3, and a 22-item Sino-Nasal Outcome Test (SNOT-22) score ≥20 were prospectively enrolled and uniformly treated with a 15-day prednisone taper and twice daily dilute budesonide irrigations. Participants were assessed at enrollment and at follow up, 2 to 5 months later. Clinical and demographic characteristics were assessed at enrollment. At both time points, CRS symptoms were assessed with SNOT-22, and polyp score (range, 0 to 6) was assessed endoscopically. Associations were determined with regression. RESULTS Pretreatment SNOT-22 score (adjusted β = -0.83; 95% CI, -1.08 to -0.58; p < 0.001) and comorbid asthma (adjusted β = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) were associated with a change in SNOT-22 experienced over the study period. Achieving a greater-than-1 minimal clinically important difference (MCID) improvement in SNOT-22 score was also associated with pretreatment SNOT-22 score (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT-22 score ≥47 had 81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID improvement. Pretreatment polyp score was not associated with any outcome metric. CONCLUSION In treatment of CRSwNP with prednisone and budesonide irrigations, pretreatment endoscopy was not informative of treatment response. Pretreatment SNOT-22 and comorbid asthma may be more predictive.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Kuiper JR, Hirsch AG, Bandeen-Roche K, Sundaresan AS, Tan BK, Kern RC, Schleimer RP, Schwartz BS. Workplace Indirect Cost Impacts of Nasal and Sinus Symptoms and Related Conditions. J Occup Environ Med 2019; 61:e333-e339. [PMID: 31205204 PMCID: PMC6766754 DOI: 10.1097/jom.0000000000001636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate associations of nasal and sinus and related symptoms, as well as selected health conditions which produce those symptoms, with total lost productive time (LPT) at work in the past 2 weeks. METHODS We used a cross-sectional analysis of 2402 currently working subjects. Self-reported physician diagnoses, condition statuses measured with standardized instruments, and symptom-based factor scores from an exploratory factor analysis were used in survey weighted log-binomial regression. RESULTS Pain and pressure, nasal blockage and discharge, and asthma and constitutional symptom factor scores as well as self-reported allergic rhinitis were associated with higher total LPT. Individuals who met operationalized criteria for multiple health conditions, especially chronic rhinosinusitis, had the greatest total LPT. CONCLUSIONS Better management of these symptoms, and awareness of how they impact an individual's ability to perform job-functions in the workplace, could improve overall productivity.
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Affiliation(s)
- Jordan R. Kuiper
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Annemarie G. Hirsch
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Agnes S. Sundaresan
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
| | - Bruce K. Tan
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert C. Kern
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert P. Schleimer
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian S. Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
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Speth MM, Phillips KM, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Longitudinal improvement in nasal obstruction symptoms of chronic rhinosinusitis directly associates with improvement in mood. Eur Arch Otorhinolaryngol 2019; 276:2827-2833. [PMID: 31325032 DOI: 10.1007/s00405-019-05569-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The effects of nasal obstruction in patients with chronic rhinosinusitis (CRS) are associated with depressed mood. We sought to validate this finding by determining whether improvement in nasal obstruction would translate to improvement in depressed mood. METHODS This was a prospective observational study of 150 patients undergoing medical management for CRS. Data were collected at two timepoints: enrollment and a subsequent follow-up visit 3-12 months later. Impact of nasal obstruction was measured using the Nasal Obstruction Symptom Evaluation (NOSE) instrument and depressed mood was measured using the 2-item Patient Health Questionnaire (PHQ-2). Sinonasal symptoms associated with CRS were also measured using the 22-item Sinonasal Outcome Test (SNOT-22). Clinical and demographic characteristics were collected. The relationship between changes in PHQ-2 and NOSE scores was determined with correlation and linear regression. RESULTS Change in PHQ-2 score was significantly correlated with change in NOSE score (ρ = 0.30, p < 0.001). After controlling for covariates, change in PHQ-2 score was associated with change in NOSE score (adjusted linear regression coefficient [β] = 0.014, 95% CI 0.006-0.022, p = 0.001). We confirmed these relationships, finding that change in PHQ-2 was associated (adjusted β = 0.037, 95% CI 0.013-0.061, p = 0.003) with change in the nasal subdomain score of the SNOT-22. Improvement in NOSE score by greater than 22 points was predictive of improvement in PHQ-2 score with sensitivity 54.5% and 83.8% specificity (p < 0.001). CONCLUSION These results provide evidence that improvements in nasal manifestations/symptoms of CRS translate to significant improvements in mood.
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Affiliation(s)
- Marlene M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Katie M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Lloyd P Hoehle
- Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC, USA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Medical Sciences Building Room 6410, 231 Albert Sabin Way, Cincinnati, OH, 45267-0528, USA.
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Phillips KM, Bergmark RW, Hoehle LP, Shu ET, Caradonna DS, Gray ST, Sedaghat AR. Differential perception and tolerance of chronic rhinosinusitis symptoms as a confounder of gender‐disparate disease burden. Int Forum Allergy Rhinol 2019; 9:1119-1124. [DOI: 10.1002/alr.22390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/23/2019] [Accepted: 07/04/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Katie M. Phillips
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
| | - Regan W. Bergmark
- Department of OtolaryngologyHarvard Medical School Boston MA
- Division of Otolaryngology‒Head and Neck SurgeryBrigham and Women's Hospital and Dana Farber Cancer Institute Boston MA
| | | | - Edina T. Shu
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
| | - David S. Caradonna
- Department of OtolaryngologyHarvard Medical School Boston MA
- Division of OtolaryngologyBeth Israel Deaconess Medical Center Boston MA
| | - Stacey T. Gray
- Department of OtolaryngologyHarvard Medical School Boston MA
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston MA
| | - Ahmad R. Sedaghat
- Department of Otolaryngology‒Head & Neck SurgeryUniversity of Cincinnati College of Medicine Cincinnati OH
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12
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Talat R, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Seasonal variations in chronic rhinosinusitis symptom burden may be explained by changes in mood. Eur Arch Otorhinolaryngol 2019; 276:2803-2809. [DOI: 10.1007/s00405-019-05555-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/09/2019] [Indexed: 12/20/2022]
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Sedaghat AR, Hoehle LP, Gray ST. Chronic rhinosinusitis control from the patient and physician perspectives. Laryngoscope Investig Otolaryngol 2018; 3:419-433. [PMID: 30599025 PMCID: PMC6302712 DOI: 10.1002/lio2.208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient-reported and physician-rated CRS disease control. STUDY TYPE Cross-sectional. METHODS A total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and also reported the number of sinus infections, CRS-related antibiotic courses taken, CRS-related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund-Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT-22 score (as well as SNOT-22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS-related antibiotics, CRS-related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT-22 score, endoscopy score, sinus infections, CRS-related antibiotic usage, CRS-related oral corticosteroid usage, and lost productivity due to CRS) and patient-reported CRS control as well as mean physician-rated CRS control. RESULTS Patient-reported global CRS control was associated only with SNOT-22 (adjusted relative risk [RR] = 0.99, 95% CI: 0.98-0.99, P < .001) but no other CRS disease characteristic. Patient-reported CRS control was specifically associated only with nasal symptoms and not extra-nasal symptoms of CRS. Physician-rated CRS control was associated with SNOT-22 score (adjusted RR [for each 1-unit increase of SNOT-22] = 0.99, 95% CI: 0.98-0.99, P < .001), number of acute bacterial CRS exacerbations-reflected by number of antibiotic courses taken (or sinus infections)-in the last 3 months (adjusted RR = 0.89, 95% CI: 0.82-0.98, P = .014) and the number of CRS-related oral corticosteroid courses taken in the last 3 months (adjusted RR = 0.87, 95% CI: 0.78-0.97, P = .012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician-rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS. CONCLUSIONS Patients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra-nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS-related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS-related oral corticosteroid use in the determination of global CRS control. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Ahmad R. Sedaghat
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMassachusettsU.S.A
- Department of Otolaryngology and Communications EnhancementBoston Children's HospitalBostonMassachusettsU.S.A
| | - Lloyd P. Hoehle
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
| | - Stacey T. Gray
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
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Campbell AP, Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Symptom control in chronic rhinosinusitis is an independent predictor of productivity loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:237-241. [PMID: 29724671 DOI: 10.1016/j.anorl.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/22/2017] [Accepted: 05/15/2017] [Indexed: 12/29/2022]
Abstract
AIMS Sinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS. MATERIALS AND METHODS Prospective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as "Not at all", "A little", "Somewhat", "Very", and "Completely". Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control. OBJECTIVE To determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS. RESULTS A total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as "not at all" was associated with 11 days of lost productivity due to CRS on univariate analysis (β=11.16, 95% CI: 5.39-16.94, P<0.001) and 8 days of lost productivity on multivariate analysis (β=8.02, 95% CI: 1.92-14.13, P=0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS. CONCLUSIONS Patient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity.
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Affiliation(s)
- A P Campbell
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - L P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - A R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, United States of America.
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