Prevalence and clinical implications of bronchiectasis in patients with overlapping asthma and chronic rhinosinusitis: a single-center prospective study

Abstract

Background As a typical “united airway” disease, asthma-chronic rhinosinusitis (CRS) overlap has recently drawn more attention. Bronchiectasis is a heterogeneous disease related to a variety of diseases. Whether bronchiectasis exists and correlates with asthma-CRS patients has not been fully elucidated. The purpose of the study was to explore the presence and characteristics of bronchiectasis in patients with overlapping asthma and CRS. Methods This report describes a prospective study with consecutive asthma-CRS patients. The diagnosis and severity of bronchiectasis were obtained by thorax high-resolution computed tomography (HRCT), the Smith radiology scale and the Bhalla scoring system. CRS severity was evaluated by paranasal sinus CT and the Lund-Mackay (LM) scoring system. The correlations between bronchiectasis and clinical data, fraction of exhaled nitric oxide, peripheral blood eosinophil counts and lung function were analyzed. Results Seventy-two (40.91%) of 176 asthma-CRS patients were diagnosed with bronchiectasis. Asthma-CRS patients with overlapping bronchiectasis had a higher incidence rate of nasal polyps (NPs) (P = 0.004), higher LM scores (P = 0.044), higher proportion of ≥ 1 severe exacerbation of asthma in the last 12 months (P = 0.003), lower postbronchodilator forced expiratory volume in one second (FEV1) % predicted (P = 0.006), and elevated peripheral blood eosinophil counts (P = 0.022). Smith and Bhalla scores were shown to correlate positively with NPs and negatively with FEV1% predicted and body mass index. Cutoff values of FEV1% predicted ≤ 71.40%, peripheral blood eosinophil counts > 0.60 × 109/L, presence of NPs, and ≥ 1 severe exacerbation of asthma in the last 12 months were shown to differentiate bronchiectasis in asthma-CRS patients. Conclusions Bronchiectasis commonly overlaps in asthma-CRS patients. The coexistence of bronchiectasis predicts a more severe disease subset in terms of asthma and CRS. We suggest that asthma-CRS patients with NPs, severe airflow obstruction, eosinophilic inflammation, and poor asthma control should receive HRCT for the early diagnosis of bronchiectasis.

The relative proportion of comorbidities among rhinitis and rhinosinusitis patients and their impact on visit burden

“…Overall, we demonstrated a high relative proportion of other chronic respiratory diseases (about 40%) in this patient population. In line with this, literature shows that up to two‐thirds of patients with CRS are affected by comorbid asthma, 4 chronic obstructive pulmonary disease, 31 or bronchiectasis 32,33 . CRS patients have decreased lung function regardless of the presence of asthma 34 .…”

“…In line with this, literature shows that up to two-thirds of patients with CRS are affected by comorbid asthma, 4 chronic obstructive pulmonary disease, 31 or bronchiectasis. 32,33 CRS patients have decreased lung function regardless of the presence of asthma. 34 Rhinitis/rhinosinusitis is the most prevalent comorbidity of asthma, and CRS has shown to increase asthma risk and vice versa.…”

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool

“… 33 , 34 , 35 In contrast, the benefit of serum immunoglobulin E (IgE) remains unclear; however, in a recent prospective study, IgE levels were significantly higher in eosinophilic CRSwNP patients. 36 EPOS 2020 defined cutoff points of serological absolute eosinophil count ≥250 μ/L, total IgE ≥100 IU/mL, or tissue eosinophils ≥10/HPF as indicators for type 2 inflammation. 3 The N‐PASS tool incorporates blood eosinophil count, tissue eosinophil count (as an option), and total IgE level as indicators of type 2 inflammation within CRSwNP patients.…”

Respiratory Reviews in Asthma 2022

“…1. Bronchiectasis in patients with overlapping asthma and chronic rhinosinusitis 1 The term "united airways" refers to the coexistence of upper and lower respiratory tract diseases and their similar pathogenic mechanisms. A typical 'united airways' disease is the asthma-chronic rhinosinusitis (CRS) overlap.…”