Asthmatic Patients with Sinusitis More Likely to Have Nasal Polyps

Some 37 million Americans suffer from sinusitis; some of those patients are unfortunate enough to also have asthma, an inflammatory disease of the lungs characterized by reversible airway obstruction. The Centers for Disease Control (CDC) estimates that more than 15 million Americans have this disorder. The association between asthma and rhinosinusitis has long been established. While this relationship is unclear, molecular research is now focusing on whether asthma and rhinosinusitis are likely upper and lower airway manifestations of the same mucosal inflammation.

As a whole, sinusitis in asthmatics tends to be more severe and resistant to medical treatment. A new study set out to the incidence of specific rhinosinusitis symptoms in asthmatics versus non-asthmatics. This entailed identifying the differences in sinusitis symptoms experienced by asthmatics versus non-asthmatics, evaluating the failure of prescription medications for treatment, and specifying and comparing the surgical treatment need.

The authors of “The Incidence and the Effect of Asthma on Consecutive Patients with Chronic Rhinosinusitis,” are Melanie W. Seybt MD, Kevin C. McMains MD, and Stilianos E. Kountakis MD PhD, all with the Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA. Their findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.

Methodology: A retrospective chart review of 145 adult patients diagnosed with sinusitis at the Medical College of Georgia Rhinology Clinic between January of 2003 and September of 2003 was performed. Data included patient age, gender, presence or absence of asthma, presence of signs and symptoms including allergic rhinitis, nasal polyposis, nasal congestion, headache/facial pain, anosmia/hyposmia, rhinorrhea, and postnasal drip. Other variables evaluated included failure of medical management (prescription drugs) and need for surgical treatment. Patients were designated as asthmatic or non-asthmatic by patient history, use of asthma medications or prior pulmonary function tests.

All patients underwent medical therapy including intranasal steroids, saline nasal spray and irrigations, high-dose guaifenesin and appropriate antibiotic therapy when indicated, before being considered for surgery.

Results: Of the 145 diagnosed with sinusitis, 64 were male, 81 were female. Their ages ranged from 18 to 83 years with a mean of 46.1. Thirty-four patients (23.4 percent) were concurrently treated for asthma while 111 (76.6 percent) were non-asthmatics. Key findings included:

Patients with asthma had a higher incidence of nasal polyps (47 percent vs. 22 percent), olfactory dysfunction (26 percent vs. six percent), and nasal congestion (85 percent vs. 60 percent) compared to patients without asthma.

Non-asthmatics had a higher incidence of headache (72 percent vs. 53 percent) and nasal discharge (58 percent vs. 38 percent) compared to patients with asthma. The incidence of post-nasal drip was similar between the two groups (29 percent for asthmatics and 31 percent for patients without asthma). The incidence of environmental allergies was similar between the two groups based on patient history, medications, and physical examination.

A higher proportion of patients with asthma required primary sinus surgery compared to that of patients without asthma (76 percent vs. 64 percent). Patients with asthma required additional sinus surgical procedures compared to patients without asthma.

Conclusion: In this study, one quarter of our consecutive patients treated for chronic rhinosinusitis at a research facility were diagnosed and actively treated for asthma. Patients with asthma have a higher incidence of nasal polyposis, nasal congestion, and olfactory disturbances. Asthmatic patients also fail primary sinus surgery more frequently and require revision surgery. The exact reason for this higher frequency of failure remains unknown, but evidence suggests a common abnormality in the respiratory epithelium [define] of the upper and lower airway in these patients. On the other hand, patients without asthma typically report a higher incidence of headache and nasal discharge. The researchers suggest that despite the often-challenging course of sinusitis in asthmatics, patients can have dramatic subjective improvement in symptoms when a full range of medical and surgical options are utilized.