Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

Abstract

Objective: We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS-related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients' quality of life (QoL).Study Design: Cross-sectional study.Methods: A total of 157 patients with CRS were prospectively recruited. CRS-specific QoL was measured using the 22-item Sinonasal Outcome Test . General health-related QoL was measured using the EuroQoL five-dimensional questionnaire visual analog scale. Associations were sought between these measures of QoL and frequency of CRS-related oral antibiotic and corticosteroid usage reported by the participants in the prior 3 and 12 months.Results: More frequent antibiotic and corticosteroid use was significantly associated with worse CRS-specific and general health-related QoL, whether querying medication use over the prior 3 months or over the prior 12 months (P < 0.001 in all cases). The effect size of CRS-related antibiotic use during the prior 3 months on CRS-specific QoL (SNOT-22 score) was significantly greater than for use during the prior 12 months. However, there was no other statistically significant difference in effect size for association between QoL and CRS-related antibiotic or corticosteroid use in the prior 3 months versus prior 12 months. These results were independent of the presence or absence of polyps.Conclusion: More frequent past CRS-related oral antibiotic and corticosteroid use, regardless of time period queried (3 months or 12 months) is associated with significant decrease in CRS-specific and general health-related QoL. CRS-related systemic medication use is an important indicator of CRS patients' QOL that easily can be queried and utilized in both clinical and research settings.

Does the oral steroid treatment of patients with nasal polyposis cause osteopenia or osteoporosis?

“…Approximation of the total past OCS consumption during the last year has been used in previous studies of CRS patients, with correlation measurements between OCS and antibiotic treatment with QoL and symptom scores. 23,24 The practice to recall the past medication during the last year by the patients' data has also been used among asthmatics 25 Interestingly, we did not find the mean BMD of the study group to be significantly reduced as measured by DXA analyses of the T-scores as well as the Z-scores. Although the mean T-value of the study group was within the normal range, 12 patients had osteopenia, and 5 had osteoporosis in the spine, according to the definition.…”

“…However, these data do not include compliance. Approximation of the total past OCS consumption during the last year has been used in previous studies of CRS patients, with correlation measurements between OCS and antibiotic treatment with QoL and symptom scores . The practice to recall the past medication during the last year by the patients' data has also been used among asthmatics…”

Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS?

“…Here, a patient questionnaire was utilized, and the time period of assessment was limited to a period of 90 days to minimize recall bias. A recent study compared CRS patients’ recall of medication usage over the previous 3‐month and 12‐month periods, noting significant correlation between the two and concluding that the 3‐month interval for antibiotic use reporting appeared to be the more clinically relevant time frame for assessing CRS‐related quality of life . For the current study hypothesis, an even longer period of time prior to ESS would be ideal to assess; perhaps this can be achieved in the future using electronic health records or system‐wide databases.…”

“…A recent study compared CRS patients' recall of medication usage over the previous 3-month and 12-month periods, noting significant correlation between the two and concluding that the 3-month interval for antibiotic use reporting appeared to be the more clinically relevant time frame for assessing CRS-related quality of life. 45 For the current study hypothesis, an even longer period of time prior to ESS would be ideal to assess; perhaps this can be achieved in the future using electronic health records or system-wide databases. ESS outcomes depend on numerous factors, and it may be difficult to design the ideal study to evaluate long-term causal effects of a single repeated intervention such as antibiotic use.…”

Relationship between chronic rhinosinusitis exacerbation frequency and asthma control

“…Intranasal corticosteroid (spray or irrigation) use as well as use of an inhaled corticosteroid were also assessed. AECRS were assessed using three previously described metrics, the number of patient‐reported 1) sinus infections, 2) CRS‐related antibiotic courses, and 3) CRS‐related oral corticosteroid courses, each in the last 3 months . All participants also completed the validated 22‐item Sinonasal Outcome Test (SNOT‐22) survey, which provides a quantitative measure of CRS symptom severity.…”