Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA, USA.
Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
Allergy. 2018 Jun;73(6):1244-1253. doi: 10.1111/all.13409. Epub 2018 Feb 7.
Nasal and sinus symptoms (NSS) are common to many health conditions, including chronic rhinosinusitis (CRS). Few studies have investigated the occurrence and severity of, and risk factors for, acute exacerbations of NSS (AENSS) by CRS status (current, past, or never met European Position Paper on Rhinosinusitis [EPOS] criteria for CRS).
Four seasonal questionnaires were mailed to a stratified random sample of Geisinger primary care patients. Logistic regression was used to identify individual characteristics associated with AENSS occurrence and severity by CRS status (current long-term, current recent, past, never) using EPOS subjective symptoms-only (EPOS ) CRS criteria. We operationalized 3 AENSS definitions based on prescribed antibiotics or oral corticosteroids, symptoms, and symptoms with purulence.
Baseline and at least 1 follow-up questionnaires were available from 4736 subjects. Self-reported NSS severity with exacerbation was worst in the current long-term CRS group. AENSS was common in all subgroups examined and generally more common among those with current EPOS CRS. Seasonal prevalence of AENSS differed by AENSS definition and CRS status. Associations of risk factors with AENSS differed by definition, but CRS status, body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted AENSS.
In this first longitudinal, population-based study of 3 AENSS definitions, NSS and AENSS were both common, sometimes severe, and differed by EPOS CRS status. Contrasting associations of risk factors for AENSS by the different definitions suggest a need for a standardized approach to definition of AENSS.
鼻和鼻窦症状（NSS）常见于许多健康状况，包括慢性鼻-鼻窦炎（CRS）。很少有研究调查过 CRS 状态（当前、过去或从未符合欧洲鼻-鼻窦炎诊疗意见书[EPOS]标准的 CRS）下急性 NSS 加重（AENSS）的发生、严重程度和危险因素。
将四季问卷邮寄给 Geisinger 初级保健患者的分层随机样本。使用逻辑回归，根据 EPOS 仅主观症状（EPOS）CRS 标准，通过 CRS 状态（当前长期、当前近期、过去、从未）识别与 AENSS 发生和严重程度相关的个体特征。我们根据处方抗生素或口服皮质类固醇、症状和有脓性分泌物的症状操作了 3 种 AENSS 定义。
4736 名受试者中有基线和至少 1 次随访问卷。自我报告的 NSS 加重严重程度在当前长期 CRS 组最差。所有亚组均存在 AENSS，且当前 EPOS CRS 者更为常见。AENSS 的季节性患病率因 AENSS 定义和 CRS 状态而异。危险因素与 AENSS 的关联因定义而异，但 CRS 状态、体重指数、哮喘、花粉症、鼻窦手术史和冬季季节始终与 AENSS 相关。
在这项关于 3 种 AENSS 定义的首次纵向、基于人群的研究中，NSS 和 AENSS 均常见，有时很严重，且与 EPOS CRS 状态不同。不同定义的 AENSS 危险因素的对比关联表明，需要采用标准化方法来定义 AENSS。
