Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Int J Chron Obstruct Pulmon Dis. 2022 Sep 7;17:2137-2147. doi: 10.2147/COPD.S372991. eCollection 2022.
Sinonasal symptoms are prevalent in COPD, and knowledge of the relationship between these symptoms and clinical markers of COPD is limited. This study explores the associations between the burden of sinonasal symptoms and clinical markers and thresholds recommended for guiding treatment decisions in the GOLD guidelines.
Sinonasal symptoms were quantified with the rhinological subscale of the Sino-Nasal-Outcome-Test (SNOT-22) in 93 COPD patients characterized by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 diagnostic criteria for rhinosinusitis without nasal polyps (RSsNP). Associations between a high burden, defined as a SNOT22_rhinological score of ≥11, and the following markers were assessed by adjusted multivariable linear regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough [Visual Analogue Scale (VAS)], physical activity [6-minute walking distance (6MWD)], mortality risk (BODE index), and HRQoL [disease-specific COPD Assessment Test (CAT) and St. Georges Respiratory Questionnaire (SGRQ), and physical component summary, Short Form-36 version 2.0 (PCS SF-36v2)]. Odds ratios for the association of a high burden and threshold levels for regular treatment were estimated by adjusted binomial logistic regression models.
A high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher BODE index and poorer HRQoL. The odds ratio of having CAT and SGRQ scores that are above the thresholds recommended for treatment was 5-7-fold greater in the high burden group.
A high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity and mortality risk and is inversely associated with physical activity and HRQoL in COPD. These findings add further support that the UAD concept also applies to COPD. Enquiry about sinonasal symptoms in COPD patients should be incorporated into the clinical routine.
鼻-鼻窦症状在 COPD 中较为常见，而这些症状与 COPD 临床标志物之间的关系尚不清楚。本研究探讨了鼻-鼻窦症状负担与 GOLD 指南中指导治疗决策的临床标志物和阈值之间的关系。
根据欧洲鼻-鼻窦炎和鼻息肉诊疗指南（EPOS）2012 年关于非鼻息肉性鼻-鼻窦炎（RSsNP）的诊断标准，93 例 COPD 患者（特征为 EPOS 2012 诊断标准）完成了鼻-鼻窦结局测试（SNOT-22）的鼻科亚量表，量化了鼻-鼻窦症状。通过调整后的多变量线性回归评估了高负担（定义为 SNOT22_rhinological 评分≥11）与以下标志物之间的关系：呼吸困难严重程度[改良的医学研究理事会（mMRC）]和咳嗽[视觉模拟量表（VAS）]、身体活动[6 分钟步行距离（6MWD）]、死亡风险（BODE 指数）和健康相关生活质量[疾病特异性 COPD 评估测试（CAT）和圣乔治呼吸问卷（SGRQ），以及物理成分综合评分，SF-36 健康调查简表 2.0 版本（PCS SF-36v2）]。通过调整后的二项逻辑回归模型，估计了高负担与常规治疗阈值之间的关联的优势比。
高负担与呼吸困难和咳嗽严重程度增加、6MWD 降低、BODE 指数增加以及 HRQoL 恶化有关。在高负担组，CAT 和 SGRQ 评分高于治疗推荐阈值的可能性是低负担组的 5-7 倍。
COPD 患者鼻-鼻窦症状负担高与症状严重程度和死亡风险的临床标志物呈正相关，与身体活动和 HRQoL 呈负相关。这些发现进一步支持 UAD 概念也适用于 COPD。在 COPD 患者中询问鼻-鼻窦症状应纳入临床常规。
