Chronic rhinosinusitis exacerbation factors identified

ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.

“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”

In an effort to identify clinical factors associated with frequent acute exacerbations in patients with chronic rhinosinusitis (CRS), Dr. Kwah of the department of internal medicine at Northwestern Medical Group, Chicago, and his associates reviewed the medical records of 3,109 patients who were treated for the condition from January 2014 to December 2015. They defined frequent exacerbators as those who were prescribed four or more antibiotics, while they defined infrequent exacerbators as those who were prescribed zero to three antibiotics. The researchers performed multivariable logistic regression controlling for race and sex for four variables of interest: allergic rhinitis, asthma, peripheral eosinophilia, and autoimmune disease.

Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.

“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”

He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.

The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.

dbrunk@frontlinemedcom.com

ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.

“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”

In an effort to identify clinical factors associated with frequent acute exacerbations in patients with chronic rhinosinusitis (CRS), Dr. Kwah of the department of internal medicine at Northwestern Medical Group, Chicago, and his associates reviewed the medical records of 3,109 patients who were treated for the condition from January 2014 to December 2015. They defined frequent exacerbators as those who were prescribed four or more antibiotics, while they defined infrequent exacerbators as those who were prescribed zero to three antibiotics. The researchers performed multivariable logistic regression controlling for race and sex for four variables of interest: allergic rhinitis, asthma, peripheral eosinophilia, and autoimmune disease.

Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.

“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”

He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.

The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.

dbrunk@frontlinemedcom.com

ATLANTA – Clinical factors associated with acute exacerbations of chronic rhinosinusitis include female sex, nonwhite race, and a higher body mass index, results from a retrospective study suggest.

“Previous research has shown associations between various risk factors and the development of chronic rhinosinusitis,” study author Jason H. Kwah, MD, said in an interview in advance of the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “However, there is minimal data regarding risk factor associations with frequent acute exacerbations of chronic rhinosinusitis. This is an important question as much of the morbidity and financial burden of this disease stems from costs and symptoms related to the management of acute exacerbations with antibiotics and steroids. If associations can be identified, the hope would be that modification of some of these risk factors could lead to improved control of the condition.”

In an effort to identify clinical factors associated with frequent acute exacerbations in patients with chronic rhinosinusitis (CRS), Dr. Kwah of the department of internal medicine at Northwestern Medical Group, Chicago, and his associates reviewed the medical records of 3,109 patients who were treated for the condition from January 2014 to December 2015. They defined frequent exacerbators as those who were prescribed four or more antibiotics, while they defined infrequent exacerbators as those who were prescribed zero to three antibiotics. The researchers performed multivariable logistic regression controlling for race and sex for four variables of interest: allergic rhinitis, asthma, peripheral eosinophilia, and autoimmune disease.

Of the 3,109 CRS patients, 936 were frequent exacerbators while 2,173 were infrequent exacerbators. Univariate analysis revealed that the following factors were associated with frequent exacerbations, compared with infrequent exacerbations: female sex, nonwhite race, higher body mass index, having any drug allergy, allergic rhinitis, peripheral eosinophilia, asthma, lower forced expiratory volume in 1 second, previous sinus surgery, severe sinusitis on CT, one or more steroid prescriptions, and the presence of autoimmune disease. Multivariate analysis adjusted for race and sex revealed that allergic rhinitis (odds ratio, 1.48), peripheral eosinophilia (OR, 1.30), asthma (OR, 1.90), and autoimmune disease (OR, 1.61) remained significantly associated with frequent CRS exacerbations.

“We found it surprising that there were so many risk factors associated with frequent acute exacerbations of CRS, as well as the strengths of these associations,” Dr. Kwah said. “Acute exacerbations of CRS cause significant morbidity and financial burden, and based on the results of our study, are likely associated with many clinically relevant risk factors. Further study is needed to confirm the presence of these associations, study the mechanism of disease, and ultimately establish treatment protocols that can improve the control of frequent acute exacerbations of CRS.”

He acknowledged certain limitations of the study, including the challenges of establishing an accurate definition for acute exacerbations of CRS in a retrospective study. “While we felt our protocol for retrospective analysis was sufficient given our inclusion criteria, a prospective trial would be helpful in further delineating the presence of acute exacerbations of CRS and how they are associated with clinical risk factors,” he said.

The study was supported in part by the NIH National Center for Advancing Translational Sciences, the Chronic Rhinosinusitis Integrative Studies Program, the Ernest Bazley Foundation, and the Division of Allergy and Immunology at the Northwestern Feinberg School of Medicine. Dr. Kwah reported having no financial disclosures.

dbrunk@frontlinemedcom.com