Clinical Factors Associated with Acute Exacerbations of Chronic Rhinosinusitis.

Clinical Factors Associated with Acute Exacerbations of Chronic Rhinosinusitis.:

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Clinical Factors Associated with Acute Exacerbations of Chronic Rhinosinusitis.

J Allergy Clin Immunol. 2020 Jan 28;:

Authors: Kwah JH, Somani SN, Stevens WW, Kern RC, Smith SS, Welch KC, Conley DB, Tan BK, Grammer LC, Yang A, Schleimer RP, Peters AT

Abstract

BACKGROUND: Chronic rhinosinusitis (CRS) is complicated by frequent acute exacerbations leading to significant healthcare burden and impaired quality of life.

OBJECTIVE: The objective of this study was to identify clinical factors associated with frequent acute exacerbations of chronic rhinosinusitis (AECRS).

METHODS: This is a retrospective cohort study of patients with CRS from January 1, 2014 to May 31, 2016. Frequent AECRS was defined as ≥4 episodes over a 12-month period in which an antibiotic was prescribed for worsening sinus symptoms and infrequent AECRS was defined as 0-3 episodes. Clinical factors including asthma, allergic rhinitis, eosinophil count ≥150 cells per microliter (≥150/μL), and autoimmune disease were evaluated for associations between the two groups.

RESULTS: Of the 3109 CRS patients identified, 600 (19.3%) were classified as having frequent exacerbations. Asthma, allergic rhinitis, eosinophil count ≥150/μL, and autoimmune disease were associated with frequent AECRS with statistically significant adjusted odds ratios (aOR) after controlling for age, race, and gender in multivariate analysis (asthma aOR 2.61, 95% CI 2.14-3.18, allergic rhinitis aOR 1.96, 95% CI 1.58-2.42, eosinophil count ≥150/μL aOR 1.54, 95% CI 1.21-1.97, and autoimmune disease aOR 1.68, 95% CI 1.36-2.07). Antibody deficiency, antibiotic allergy, lower FEV1, radiographic sinus disease severity, nasal polyposis, and systemic corticosteroid use were also associated with frequent AECRS.

CONCLUSION: Patients with frequent episodes of AECRS were characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count ≥150/μL, autoimmune disease, and other allergic and immunologic diseases. These findings identify a high-risk phenotype of patients with CRS for preventative interventions to reduce exacerbation frequency.

CLINICAL IMPLICATIONS: This study characterizes patients with CRS at high-risk for recurrent exacerbations requiring frequent courses of antibiotics and steroids who can benefit from targeted interventions to reduce exacerbation frequency.

PMID: 32004523 [PubMed - as supplied by publisher]