Phillips K M, Hoehle L P, Bergmark R W, Campbell A P, Caradonna D S, Gray S T, Sedaghat A R
Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
Rhinology. 2017 Sep 1;55(3):211-217. doi: 10.4193/Rhin17.029.
Chronic rhinosinusitis (CRS) is highly prevalent in patients with asthma. However, no study has evaluated the effect of CRS severity on asthma-related oral corticosteroid use - a marker of poor asthma control and prognosis. We therefore sought to evaluate the association between CRS severity and asthma-related oral corticosteroid use.
Prospective cross-sectional study of 110 adult asthmatic CRS patients. CRS severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy score. Number of asthma-related courses of oral corticosteroids in the past year was queried at enrollment. Association was sought between metrics for CRS severity and asthma-related oral corticosteroids use in the last year. Receiver operating characteristic (ROC) curves defined whether SNOT-22 or endoscopy scores could be used for detecting asthma-related oral corticosteroid use.
The mean SNOT-22 score was 44.9 (standard deviation [SD] : 23.3) and mean endoscopy score was 4.1 (SD: 3.0). The mean number of asthma-related oral corticosteroid courses taken in the last year was 1.1 (SD: 1.9). SNOT-22, but not endoscopy score, was associated with requiring at least one course of asthma-related oral corticosteroids in the last year (odds ratio = 1.03, 95%CI: 1.02 - 1.06, p=0.003), which translates to an odds ratio of 2.0 for a 21-point increase in SNOT-22. ROC analysis identified equally optimal SNOT-22 scores of greater than 32 (sensitivity: 88.1%, specificity: 41.2%) or greater than 65 (sensitivity: 38.1%, specificity: 91.2%) for detecting the need for at least one course of oral corticosteroids within the past year.
CRS symptom severity is associated with past asthma-related oral corticosteroid use. SNOT-22 scores may be used as a versatile tool to screen for past asthma-related oral corticosteroid use in asthmatic CRS patients - i.e. those at greatest risk from their asthma - with either high sensitivity or high specificity.
慢性鼻-鼻窦炎（CRS）在哮喘患者中高度流行。然而，尚无研究评估CRS严重程度对哮喘相关口服糖皮质激素使用的影响，而哮喘相关口服糖皮质激素使用是哮喘控制不佳和预后不良的一个指标。因此，我们试图评估CRS严重程度与哮喘相关口服糖皮质激素使用之间的关联。
对110例成年哮喘合并CRS患者进行前瞻性横断面研究。使用22项鼻鼻窦结局测试（SNOT-22）和Lund-Kennedy内镜评分来衡量CRS的严重程度。在入组时询问过去一年中哮喘相关口服糖皮质激素疗程的数量。研究CRS严重程度指标与过去一年中哮喘相关口服糖皮质激素使用之间的关联。采用受试者操作特征（ROC）曲线来确定SNOT-22或内镜评分是否可用于检测哮喘相关口服糖皮质激素的使用情况。
SNOT-22平均评分为44.9（标准差[SD]：23.3），内镜平均评分为4.1（SD：3.0）。过去一年中哮喘相关口服糖皮质激素疗程的平均数量为1.1（SD：1.9）。SNOT-22评分与过去一年中至少需要一个疗程哮喘相关口服糖皮质激素有关，而内镜评分则无关（优势比=1.03，95%置信区间：1.02-1.06，p=0.003），这意味着SNOT-22评分增加21分时优势比为2.0。ROC分析确定，对于检测过去一年中至少需要一个疗程口服糖皮质激素的需求，SNOT-22评分大于32（敏感性：88.1%，特异性：41.2%）或大于65（敏感性：38.1%，特异性：91.2%）具有同样最佳的效果。
CRS症状严重程度与过去哮喘相关口服糖皮质激素的使用有关。SNOT-22评分可作为一种通用工具，用于筛查哮喘合并CRS患者（即哮喘风险最高的患者）过去哮喘相关口服糖皮质激素的使用情况，具有高敏感性或高特异性。
