Differential perception and tolerance of chronic rhinosinusitis symptoms as a confounder of gender‐disparate disease burden

2019 ◽  
Vol 9 (10) ◽  
pp. 1119-1124 ◽  
Author(s):  
Katie M. Phillips ◽  
Regan W. Bergmark ◽  
Lloyd P. Hoehle ◽  
Edina T. Shu ◽  
David S. Caradonna ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Differential Perception

Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

2019 ◽  
Vol 161 (5) ◽  
pp. 890-896 ◽  
Author(s):  
Katie M. Phillips ◽  
Eric Barbarite ◽  
Lloyd P. Hoehle ◽  
David S. Caradonna ◽  
Stacey T. Gray ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Cross Sectional ◽  
Patient Reported ◽  
Oral Corticosteroids ◽  
Sinonasal Outcome Test ◽  
Snot 22

Objective Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). Study Design Cross-sectional. Setting Tertiary care rhinology clinic. Subjects Patients with CRS (N = 209). Methods Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. Results An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [ORadj] = 3.68, 95% CI: 1.42-9.50, P = .007) and SNOT-22 (ORadj = 1.06, 95% CI: 1.04-1.09, P < .001). Polyps were negatively associated (ORadj = 0.27, 95% CI: 0.11-0.68, P = .005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. Conclusions In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.

Disease Burden of Chronic Rhinosinusitis (CRS) is as Severe as Other Serious Chronic Diseases

2018 ◽  
Vol 141 (2) ◽  
pp. AB165
Author(s):  
Eric J. Schenkel ◽  
John C. Messina ◽  
Andy Bodine ◽  
James S. Mcginley ◽  
R.J. Wirth ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Chronic Rhinosinusitis ◽  
Disease Burden

Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
K.M. Phillips ◽  
F.A. Houssein ◽  
K. Singerman ◽  
L.M. Boeckermann ◽  
A.R. Sedaghat
Keyword(s):  
Disease Control ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Disease Burden ◽  
Valid Measure ◽  
Patient Reported ◽  
Vas Scores ◽  
Prospective Longitudinal ◽  
Snot 22

Background: Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. Methods: Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as “not at all,” “a little,” “somewhat,” “very,” or “completely”, as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. Results: At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. “very” or “completely”) controlled CRS. Conclusions: Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.

The Association of Serum Eosinophilia with Structured Histopathology in Chronic Rhinosinusitis

2019 ◽  
Vol 129 (5) ◽  
pp. 512-516 ◽  
Author(s):  
Ashwin Ganti ◽  
Hannah N. Kuhar ◽  
Michael Eggerstedt ◽  
Mahboobeh Mahdavinia ◽  
Paolo Gattuso ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Complete Blood Count ◽  
Severe Disease ◽  
Normal Serum ◽  
Sinus Surgery ◽  
High Power Field ◽  
Level Of Evidence ◽  
Preoperative Serum ◽  
Number Of Patients

Background: Prior studies have demonstrated associations between serum eosinophilia and chronic rhinosinusitis (CRS) pathogenesis. However, the association of serum eosinophilia with histopathology profiling in CRS has not been fully delineated and may help better characterize CRS disease burden prior to surgery. Methods: A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Complete blood count (CBC) with differential was drawn within 4 weeks prior to FESS. Serum eosinophilia was defined as >6.0% (>0.60 th/μL). Histopathology variables were compared among patients. Results: A total of 177 CRS patients (37 with serum eosinophilia and 140 with normal serum eosinophilia) were analyzed. Compared to CRS patients with normal serum eosinophil counts, CRS patients with serum eosinophilia demonstrated increased polypoid disease (67.6% vs 35.0%, P < .001), eosinophil aggregates (45.9% vs 20.7%, P = .003), and eosinophils per high-power field (>5/HPF) (67.6% vs 40.7%, P = .003). Conclusion: CRS patients with serum eosinophilia demonstrated severe disease burden on histopathology with high levels of polypoid disease and tissue eosinophilia. However, a considerable number of patients without serum eosinophilia demonstrated eosinophilic disease on histopathology, indicating that preoperative serum eosinophilia alone could not be reliably used to predict eosinophilic CRS. Level of evidence: 4

Chronic rhinosinusitis disease burden is associated with asthma-related emergency department usage

2020 ◽  
Author(s):  
Claire Gleadhill ◽  
Marlene M. Speth ◽  
Isabelle Gengler ◽  
Katie M. Phillips ◽  
Lloyd P. Hoehle ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Rhinosinusitis ◽  
Disease Burden

An Evaluation of SPARC Protein as a Serum Biomarker of Chronic Rhinosinusitis

2018 ◽  
Vol 160 (1) ◽  
pp. 158-164 ◽  
Author(s):  
Marc-Henri Asmar ◽  
Annie Gaudreau ◽  
Anastasios Maniakas ◽  
Leandra Mfuna Endam ◽  
Martin Desrosiers
Keyword(s):  
Disease Activity ◽  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Care Center ◽  
Tertiary Care ◽  
Response To Therapy ◽  
Serum Biomarker ◽  
Sinus Surgery ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mesenchymal Transition

Objective Precision medicine initiatives for chronic rhinosinusitis (CRS) management suggest tailoring treatment to the patient’s individual disease profile; however, serum biomarkers for evaluation of disease activity or predicting response to therapy are lacking in CRS. Epithelial-to-mesenchymal transition (EMT) has been described as a component of barrier dysfunction in CRS. SPARC (secreted protein acidic and rich in cysteine) is a marker of EMT that has previously been identified in sinus epithelium by gene expression profiling. We wished to determine if SPARC could represent a serum biomarker for CRS by verifying (1) if SPARC could be detected in serum, (2) whether levels were sensitive to disease burden reduction following surgery, and (3) if it could predict response to therapy. Study Design Prospective. Setting Tertiary care center. Subjects Patients with CRS undergoing endoscopic sinus surgery (ESS). Methods Twenty-six patients undergoing ESS for CRS were prospectively recruited. Serum was collected at the time of surgery and 4 months following ESS and SPARC level measured using enzyme-linked immunosorbent assay. Postoperative outcome was characterized as “remission” or “unfavorable” based on symptomatology and endoscopy. Results SPARC could be detected and measured in serum in all subjects. Following ESS, SPARC levels decreased by 33% ( P = .005) but did not predict evolution at 4 months postsurgery ( P = .94). Conclusion SPARC may be an interesting serum biomarker of disease activity in CRS, as it can be reliably measured and decreases following successful reduction of disease burden after surgery. However, it does not predict post-ESS evolution, suggesting that the link between EMT and outcome is not linear.

scholarly journals Validity of systemic antibiotics and systemic corticosteroid usage for chronic rhinosinusitis as metrics of disease burden

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
K.M. Phillips ◽  
M.M. Speth ◽  
E.T. Shu ◽  
R. Talat ◽  
D.S. Caradonna ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Systemic Corticosteroid ◽  
Systemic Antibiotics

scholarly journals Patients Unmet Needs in Chronic Rhinosinusitis With Nasal Polyps Care: A Patient Advisory Board Statement of EUFOREA

2021 ◽  
Vol 2 ◽  
Author(s):  
N. Claeys ◽  
M. T. Teeling ◽  
P. Legrand ◽  
M. Poppe ◽  
P. Verschueren ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Disease Burden ◽  
Unmet Needs ◽  
Treatment Options ◽  
Well Being ◽  
Advisory Board ◽  
Sinus Surgery ◽  
Poor Sleep ◽  
Coordination Of Care

Background: European patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have had only limited occasions to unite to have their voices heard, hence missing the opportunity to contribute to the improvement of CRSwNP care.Aims: To identify unmet needs in CRSwNP from the perspective of CRSwNP patients from the Patient Advisory Board (PAB) of the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA).Methodology: Semi-structured interviews were conducted individually with 15 European patients with CRSwNP and with a disease history of more than 2 years. Patients shared their burden of the disease and frustrations related to CRSwNP care, experiences with key pillars of current treatment options, shortcomings of the current care pathways and recommendations for improvement of care. A panel of 30 members of the Patient Advisory Board reviewed the interview report and provided further input during 2 virtual meetings.Results: CRSwNP patients indicated the need for greater awareness from society and physicians of the disease burden with impact on social function and well-being. Along with a loss of ability to smell and the continuous presence of secretions in the nose, most patients reported poor sleep quality and psychological impact as the most bothersome symptoms. Patients' frustrations relate primarily to the underestimation of the disease burden, the lack of coordination of care and the limited treatment options available to them. Treatment options with oral corticosteroids and/or sinus surgery both have positive and negative aspects, including the lack of long-lasting efficacy. Better coordination of care, more patient-centered care, greater public awareness, increases in research on the disease mechanisms and better therapeutic options would be warmly welcomed by CRSwNP patients.Conclusions: This statement of the EUFOREA Patient Advisory Board on CRSwNP provides novel insights on the underestimation of the burden of CRSwNP and shortcomings of current care. Multiple recommendations made by the patients can underpin action plans for implementation of better care for CRSwNP among all physicians treating patients with this disabling disease.

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