Clinical factors associated with acute exacerbations of chronic rhinosinusitis

• Published in: Journal of allergy and clinical immunology 2020-06, Vol.145 (6), p.1598-1605
• Main Authors: Kwah, Jason H., Somani, Shaan N., Stevens, Whitney W., Kern, Robert C., Smith, Stephanie S., Welch, Kevin C., Conley, David B., Tan, Bruce K., Grammer, Leslie C., Yang, Amy, Schleimer, Robert P., Peters, Anju T.
• Format: Article
• Language: English
• Subjects: Acute Disease; allergic rhinitis; Anti-Bacterial Agents - therapeutic use; antibiotics; asthma; Asthma - drug therapy; Asthma - pathology; autoimmune disease; Autoimmune Diseases - drug therapy; Autoimmune Diseases - pathology; Chronic Disease; Chronic rhinosinusitis; eosinophils; Eosinophils - drug effects; Eosinophils - pathology; exacerbation; Female; Humans; Male; Middle Aged; Nasal Polyps - drug therapy; Nasal Polyps - pathology; Quality of Life; Retrospective Studies; Rhinitis, Allergic - pathology; Severity of Illness Index; Sinusitis - drug therapy; Sinusitis - pathology; Symptom Flare Up
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2020.01.023

Chronic rhinosinusitis (CRS) is complicated by frequent acute exacerbations leading to significant health care burden and impaired quality of life. The objective of this study was to identify clinical factors associated with frequent acute exacerbation of CRS (AECRS). This is a retrospective cohort study of patients with CRS from January 1, 2014, to May 31, 2016. Frequent AECRS was defined as at least 4 episodes over a 12-month period in which an antibiotic was prescribed for worsening sinus symptoms, and infrequent AECRS was defined as 0 to 3 episodes. Clinical factors, including asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease, were evaluated for associations between the 2 groups. Of the 3109 patients with CRS who were identified, 600 (19.3%) were classified as having frequent exacerbation. Asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease were associated with frequent AECRS with statistically significant adjusted odds ratios (aORs) after controlling for age, race, and sex 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 of at least 150 cells per microliter 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. Patients with frequent episodes of AECRS were characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, autoimmune disease, and other allergic and immunologic diseases. These findings identify a high-risk phenotype of patients with CRS for preventive interventions to reduce exacerbation frequency. [Display omitted]