Clinical factors associated with acute exacerbations of chronic rhinosinusitis

Kwah, Jason; Somani, Shaan N.; Stevens, Whitney W.; Kern, Robert C.; Smith, Stephanie Shintani; Welch, Kevin C.; Conley, David B.; Tan, Bruce K.; Grammer, Leslie C.; Yang, Amy; Schleimer, Robert P.; Peters, Anju T.

doi:10.1016/j.jaci.2020.01.023

Cited by 21 publications

(20 citation statements)

References 32 publications

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“…In addition, the articles reviewed included patients at various stages of intervention or recent antimicrobial treatment. It is also worth noting that patients with AECRS are known to have higher prevalence of comorbid conditions including allergic rhinitis, asthma, autoimmune, or other atopic diseases ( Kwah et al., 2020 ). Most of the included studies lacked comprehensive demographic data regarding these and other relevant comorbidities such as respiratory pathologies, diabetes, or extensive obstructive polyposis.…”

Section: Discussionmentioning

confidence: 99%

The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review

Okifo

Ray

Gudis

2022

Front. Cell. Infect. Microbiol.

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BackgroundAcute exacerbations (AE) in chronic rhinosinusitis (CRS) are a common and important clinical issue. However, relatively little is known regarding the underlying microbiology that drives exacerbations or how it relates to the microbiome of CRS. The purpose of this study is to examine the literature to characterize the microbiome associated with acute exacerbations in a chronic rhinosinusitis setting. Understanding this disease process may facilitate targeted antibiotic therapy, reduced antibiotic resistance, and offer more effective disease control and treatment efficacy.ObjectiveTo characterize the microbiome associated with acute exacerbations of chronic rhinosinusitis (AECRS).MethodsWe conducted a systematic review of the literature on Medline, Embase, and Web of Science databases from January 1990-June 2021 to identify studies related to AE in CRS. Exclusion criteria include non-English, non-human studies, and case reports. Studies without culture or PCR data were also excluded.ResultsFourteen studies were identified which provided detailed data regarding sinus microbiome in AECRS patients. In these patients, a total of 1252 individual isolates were identified. While common acute pathogens were identified in high frequencies in the sinonasal cultures (Staphylococcus pneumonia, Haemophilus influenza), the predominant bacteria were Staphylococcus aureus (including methicillin-sensitive Staphylococcus aureus) and Pseudomonas aeruginosa. Patient characteristics that may represent higher risk phenotypes were not consistently collected in the studies. Discussion of antimicrobial sensitivities and/or resistance were included in 7/14 studies.ConclusionsThis systematic review identifies the predominant microbiology species that may contribute to AECRS. Further studies are needed to understand the pathogenic role of bacteria and viruses in AECRS and to identify associated comorbidities and patient phenotypes that may predispose to AE. The optimal treatment regimen for AECRS remains unclear.

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Section: Discussionmentioning

confidence: 99%

The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review

Okifo

Ray

Gudis

2022

Front. Cell. Infect. Microbiol.

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“… 17 Other studies have used surrogate measures of AECRS to quantify AECRS frequency, such as the frequency of sinus infections and/or frequency of rescue medication (i.e., antibiotics or oral corticosteroids). 2 , 15 , 18 , 19 , 20 , 21 Finally, endoscopic findings have also been used to define AECRS in the literature. Evidence of mucopurulent drainage on endoscopy is frequently used, particularly in studies on the bacteriology of AECRS.…”

Section: Definitionmentioning

confidence: 99%

“… 21 , 25 This has been validated using the frequency of internet search trends in the Northern and Southern Hemispheres, as well as in English and non‐English speaking countries. 26 Although aeroallergen hypersensitivity has been shown to be a disease modifier in CRS, 1 , 19 studies into temporal trends have not supported an increase in AECRS during “peak allergy seasons,” or transitions between seasons. 26 …”

Section: Epidemiologymentioning

confidence: 99%

“… 1 In a retrospective review of over 3000 patients with CRS, 19.3% were found to have meet this criteria for exacerbation‐prone CRS, with at least 4 AECRS (defined by an antibiotic course prescribed for worsening sinus symptoms) over a 12 months period. 19 Our prior work found that the exacerbation‐prone phenotype of CRS was associated with high sinonasal symptom burden (defined by a 22‐item Sinonasal Outcome Test [SNOT‐22] score >23) and comorbid asthma but negatively associated with nasal polyps. 18 A more recent study by Kwah et al found that the exacerbation‐prone phenotype of CRS was associated with increased BMI, nonwhite race, female sex, eosinophil count of at least 150 cells/ml, and presence of comorbidities (asthma, allergic rhinitis, autoimmune disease, and any drug or antibiotic allergy).…”

Section: Epidemiologymentioning

confidence: 99%

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Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

Walters

Sedaghat

Phillips

2022

Laryngoscope Investig Oto

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Objectives: Acute exacerbations of chronic rhinosinusitis (AECRS) are distinct from baseline symptomatology related to chronic rhinosinusitis (CRS). In this review, we seek to examine the literature on AECRS to synthesize the definition, epidemiology, pathophysiology, treatment, and impact of AECRS on CRS patients.Methods: A comprehensive narrative review of the scientific literature, identified by searching PubMed from inception through April 2022, was performed.Results: AECRS is defined in consensus guidelines as a worsening of chronic sinus disease symptomatology, with a return to baseline, typically after intervention with systemic antibiotics and/or corticosteroids. The working definition used across the literature, however, is broad and heterogeneous. The pathophysiology of AECRS is incompletely understood but is hypothesized to include an interplay of environmental and patient-specific factors. AECRS have been found to have a negative impact on quality-of-life measures, independent of baseline CRS symptomatology, and impact how patients and physicians view overall disease control. Treatment for AECRS includes oral antibiotics and systemic corticosteroids, although their efficacy for AECRS is unclear. Appropriate use of medical and surgical treatment for CRS can reduce the frequency of AECRS.Conclusions: AECRS are a distinct entity in CRS patients and should be independently assessed when evaluating patients for CRS control. The efficacy of systemic medication usage for AECRS is currently unclear, but appropriate medical management of baseline CRS can reduce the frequency of AECRS. More research is needed to further understand this phenomenon, including a more precise and prospective definition, defined epidemiology, and how to appropriately treat.

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“…Conversely, the presence of asthma adversely affects the course of CRS (102) and is associated with higher frequency of CRS exacerbations (103,104), reduced local response to CSs (105), prolonged systemic therapy (oral corticosteroid or biologics) after surgical treatment of patients with CRS (106), greater chance of recurrence of CRS after surgery (107), and increased risk of perioperative complications (108).…”

Section: Crs and Asthmamentioning

confidence: 99%

Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

et al. 2021

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The large amount of evidence and the renewed interest on upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma excecutive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change.UAD refer to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan.The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and homebased continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD.Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.

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Clinical factors associated with acute exacerbations of chronic rhinosinusitis

Cited by 21 publications

References 32 publications

The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review

The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review

Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

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