Longitudinal Evaluation of Chronic Rhinosinusitis Symptoms in a Population-Based Sample

Sundaresan, Agnes S.; Hirsch, Annemarie G.; Young, Amanda; Pollak, Jonathan; Tan, Bruce K.; Schleimer, Robert P.; Kern, Robert C.; Kennedy, Thomas L.; Greene, J. Scott; Stewart, Walter F.; Bandeen‐Roche, Karen; Schwartz, Brian S.

doi:10.1016/j.jaip.2017.10.012

Cited by 17 publications

(18 citation statements)

References 45 publications

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“…However, this could still result in large differences in proportions meeting EPOS s criteria for CRS over time and lead to misclassification of CRS status when symptoms are assessed at cross section. For example, we have previously reported that, among subjects who met EPOS s current CRS at baseline, almost half did not meet criteria for current CRS 6 months later . The latent constructs, however, were stable over time.…”

Section: Discussionmentioning

confidence: 95%

“…The questionnaires included items on the presence, frequency, severity, and bother of a range of symptoms associated with sinonasal disease and comorbid conditions (Table ) . Each questionnaire included 37 questions in common with the same response options (how often the symptom occurred in the past 3 months as 1 = never, 2 = once in a while, 3 = some of the time, 4 = most of the time, or 5 = all the time; Table ).…”

Section: Methodsmentioning

confidence: 99%

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Longitudinal evaluation of clustering of chronic sinonasal and related symptoms using exploratory factor analysis

Cole

Bandeen‐Roche

Hirsch

et al. 2018

Allergy

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Background: Sinonasal symptoms are common and can have several underlying causes. When symptoms occur in specified patterns lasting three months or more they meet criteria for chronic rhinosinusitis (CRS). Approaches to CRS symptom measurement do not specify how to measure symptoms and treat six sinonasal symptoms as generally interchangeable, suggesting that such symptoms should cluster on one or two latent factors. Methods: We used questionnaire responses to 37 questions on presence, severity, bother, and frequency of cardinal sinonasal and related symptoms lasting three months, from 3535 subjects at three time points over 16 months. We completed five exploratory factor analyses (EFA) to identify symptom clustering, one for each time point and two for the differences between adjacent questionnaires. The baseline EFA was used to provide factor scores that were described longitudinally and examined by CRS status. Results: Five EFAs identified the same five factors (blockage and discharge, pain and pressure, asthma and cold/flu symptoms, smell loss, and ear and eye [mainly allergy] symptoms), with clustering determined by symptom frequency, severity, and degree of bother. Responses to individual questions showed changes over time but when combined into factor scores showed less longitudinal change. All symptom factor scores were progressively higher from never to past to current CRS status. Conclusions: Although the current approaches to symptom characterization in CRS imply a single underlying latent construct, our results suggest that there are at least three latent constructs relevant to CRS. Further studies are needed to evaluate if these clusters have identifiable underlying pathobiologies.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Longitudinal evaluation of clustering of chronic sinonasal and related symptoms using exploratory factor analysis

Cole

Bandeen‐Roche

Hirsch

et al. 2018

Allergy

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“…Demographic data were obtained from electronic health records. Migraine headache, asthma, and anxiety sensitivity index (ASI) data were collected via CRISP questionnaires . Migraine headache status was based on the ID Migraine questionnaire, and asthma was based on self‐report of a doctor diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population‐based sample

Hirsch

Nordberg

Bandeen‐Roche

et al. 2019

Allergy

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Allergy. 2020;75:911-920.wileyonlinelibrary.com/journal/all | 911 Abstract Background: Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings.Objective: To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample. Methods:We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200 769 primary care patients. Symptom status (CRS S ) was based on guideline criteria, and objective radiologic inflammation (CRS O ) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRS S+O . We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRS S+O .Using weighted analysis, we calculated estimates for the source population. Results:The proportion of women with L-M scores ≥ 3, 4, or 6 (CRS O ) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRS S+O was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRS S+O compared to women. A greater proportion of men (vs women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses. Conclusion:In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRS S+O . K E Y W O R D S chronic rhinosinusitis, CT scan, epidemiology, sex, sinus S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Hirsch AG, Nordberg C, Bandeen-Roche K, et al. Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample.Allergy. 2020;75:911-920. https ://doi.

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“…In a longitudinal study of adults reporting CRS symptoms in a US general population, the lifetime prevalence of CRS was estimated to be 27.5% with an annual cumulative incidence of almost 2%. 25 As a comparison, the lifetime prevalence of asthma in adults was 13.9% according to the 2016 National Health Interview Survey. 7 The annual cost of these diseases has been estimated to be between $22 to $33 billion for CRS [26][27][28] and $81.9 billion for asthma.…”

Section: Chronic Rhinosinusitismentioning

confidence: 99%

Sinus Infections, Inflammation, and Asthma

Staudacher

Stevens

2019

Immunology and Allergy Clinics of North America

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KEYWORDSAcute rhinosinusitis Chronic rhinosinusitis Nasal polyp Infection Inflammation Asthma Microbiome KEY POINTSRhinosinusitis is clinically defined as the presence of nasal drainage (anterior or posterior), nasal congestion, facial pain/pressure, and/or reduced sense of smell. In acute rhinosinusitis, nasal symptoms last for less than 12 weeks and inflammation is often secondary to a viral or bacterial infection. In chronic rhinosinusitis (CRS), nasal symptoms persist for longer than 12 weeks and the inflammation observed is secondary to impairments in the epithelial barrier, dysregulation of the host immune response, and potentially infections (or colonization) by pathogens. CRS and asthma have a strong clinical association and share similar pathophysiologic mechanisms in support of the unified airway hypothesis.Acute rhinosinusitis (ARS) is defined as the presence of nasal drainage (anterior or posterior), nasal congestion, facial pain/pressure, and/or reduced sense of smell. Depending on which guidelines are followed, ARS symptoms last either for less than 4 weeks 1 or 12 weeks. 2,3 ARS is a clinical diagnosis, and objective confirmation by sinus computed tomography (CT) scan or nasal endoscopy is generally not indicated. Patients can have more than one episode of ARS each year but importantly, they are asymptomatic in the intervening periods.Acute rhinosinusitis is extremely common. Studies specifying ARS found a disease prevalence of 6% to 15%, 2,4 with an estimated 0.035% of the population suffering from recurrent episodes. 5 Between 2006 and 2010, there were an estimated 21.4 million ambulatory care visits with a primary diagnosis of ARS. 6 Furthermore, in 2015 alone, acute upper respiratory infection (or presumed ARS) was one of the top 20 leading diagnoses for outpatient office visits. 7

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Longitudinal Evaluation of Chronic Rhinosinusitis Symptoms in a Population-Based Sample

Abstract: Less than half with nasal and sinus symptoms meeting CRS EPOS criteria in our general, regional population had symptom persistence over time, with symptom profiles at baseline and age of onset being strongly associated with stability of symptoms.

Cited by 17 publications

References 45 publications

Longitudinal evaluation of clustering of chronic sinonasal and related symptoms using exploratory factor analysis

Longitudinal evaluation of clustering of chronic sinonasal and related symptoms using exploratory factor analysis

Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population‐based sample

Sinus Infections, Inflammation, and Asthma

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