Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Int Forum Allergy Rhinol. 2018 Apr;8(4):495-503. doi: 10.1002/alr.22064. Epub 2018 Jan 5.
Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics.
At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses.
A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).
While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.
慢性鼻-鼻窦炎（CRS）与合并哮喘密切相关。本研究通过患者报告和临床特征比较 CRS 人群中的早发性和迟发性哮喘。
在临床登记处入组时，CRS 患者完成了 22 项鼻-鼻窦结局测试（SNOT-22）、哮喘控制测试（ACT）、迷你哮喘生活质量问卷（miniAQLQ）、29 项患者报告结局测量信息系统（PROMIS-29）和用药问卷。患者还报告了合并哮喘和首次哮喘诊断的年龄。定义早发性（<18 岁）和迟发性（>18 岁）哮喘组。采用方差分析（ANOVA）、卡方检验和 Kruskal-Wallis 检验比较患者的反应。
共完成了 199 例非哮喘（56.1%）、71 例早发性哮喘（20.0%）和 85 例迟发性哮喘（23.9%）CRS 患者的调查。迟发性哮喘患者的体重指数（BMI）显著高于早发性哮喘（p = 0.046），而年龄、性别、种族和吸烟史与哮喘发病时间无差异。哮喘组间 SNOT-22、ACT 和 miniAQLQ 无差异，但迟发性哮喘患者的身体功能明显低于非哮喘患者（p = 0.008）。与非哮喘患者相比，迟发性哮喘患者鼻息肉发生率更高（p<0.001），Lund-Mackay 评分更高（p=0.005），CRS 管理中接受的口服类固醇疗程更多（p<0.001）和内镜手术更多（p=0.008）。与早发性哮喘患者相比，迟发性哮喘患者鼻息肉（p=0.011）和 CRS 的口服类固醇疗程（p=0.003）更多。
虽然各组间 CRS 特异性和哮喘特异性患者报告结局测量（PROMs）无显著差异，但迟发性哮喘的 CRS 患者身体功能较差，鼻息肉更频繁，需要更多的 CRS 治疗。迟发性哮喘可能预示着 CRS 更严重的疾病。
