Background
Methods
Study and participants
FeNO analysis
Asthma assessment with spirometry
Radiological diagnosis and severity assessment of bronchiectasis by using HRCT
CRS analysis using paranasal sinus CT
Statistical analysis
Results
Patient characteristics
Characteristics | Values |
---|---|
Male sex, n (%) | 89 (50.57) |
Age, y | 53.90 ± 14.26 (51.78–56.03) |
BMI, kg/m2 | 24.56 ± 3.94 (23.98–25.15) |
Positive smoking statusa, n (%) | 55 (31.25) |
Smoking indexb, pack-years | 10.00 (8.00,14.00) |
Duration of asthma, y | 6.50 (2.00,18.00) |
NPs, n (%) | 82 (46.59) |
Prior sinus surgery, n (%) | 34 (19.32) |
Allergic rhinitis, n (%) | 112 (63.64) |
Atopic dermatitis, n (%) | 14 (7.95) |
Gastroesophageal reflux disease, n (%) | 14 (7.95) |
ICS dose (fluticasone equivalent), μg/d | 320.00 (160.00, 320.00) |
Severe asthma, n (%) | 26 (14.77) |
≥ 1 severe exacerbation of asthma in the last 12 months, n (%) | 54 (30.68) |
≥ 1 pneumonia in the last 12 months, n (%) | 51 (28.98) |
Peripheral blood eosinophil counts, × 109/L | 0.37 (0.20,0.70) |
FeNO, ppb | 36.50 (18.00, 66.00) |
Total IgE, IU/mL | 177.00 (48.83, 356.50) |
Atopy, n (%) | 91 (51.70) |
Postbronchodilator FEV1% predicted, % | 79.10 ± 19.91 (76.13–82.06) |
LM scores | 10.00 (6.00, 17.00) |
Bronchiectasis in HRCT, n (%) | 72 (40.91) |
Characteristics of asthma-CRS patients overlapping with bronchiectasis
Variables | Nonbronchiectasis group (n = 104) | Bronchiectasis group (n = 72) | P Value |
---|---|---|---|
Male sex, n (%) | 51 (49.04) | 38 (52.78) | 0.626 |
Age, y | 53.28 ± 14.66 (50.43–56.13) | 54.81 ± 13.71 (51.58–58.03) | 0.487 |
BMI, kg/m2 | 24.87 ± 3.61 (24.17–25.57) | 24.12 ± 4.37 (23.09–25.14) | 0.213 |
Positive smoking statusa, n (%) | 31 (29.81) | 24 (33.33) | 0.620 |
Smoking indexb, pack-years | 10.00 (8.00,14.00) | 8.00 (6.25,13.50) | 0.113 |
Duration of asthma, y | 5.50 (1,12.75) | 8.00 (2.00, 20.00) | 0.171 |
NPs, n (%) | 35 (33.65) | 40 (55.56) | 0.004 |
Prior sinus surgery, n (%) | 16 (15.38) | 18 (25.00) | 0.112 |
Allergic rhinitis, n (%) | 63 (60.58) | 49 (68.06) | 0.311 |
Atopic dermatitis, n (%) | 11 (10.58) | 3 (4.17) | 0.122 |
Gastroesophageal reflux disease, n (%) | 9 (8.65) | 5 (6.94) | 0.680 |
ICS dose (fluticasone equivalent), μg/d | 320.00 (160.00, 320.00) | 285.00 (160.00, 320.00) | 0.713 |
Severe asthma, n (%) | 11 (10.58) | 15 (20.83) | 0.059 |
≥ 1 severe exacerbation of asthma in the last 12 months, n (%) | 23 (22.12) | 31 (43.06) | 0.003 |
≥ 1 pneumonia in the last 12 months, n (%) | 27 (25.96) | 24 (33.33) | 0.289 |
Peripheral blood eosinophil counts, × 109/L | 0.32 (0.15, 0.58) | 0.44 (0.23, 0.90) | 0.022 |
FeNO, ppb | 32.00 (18.00, 61.75) | 44.00 (23.00,74.75) | 0.056 |
Total IgE, IU/mL | 135.50 (48.10, 285.50) | 232.00 (56.75,525.25) | 0.044 |
Atopy, n (%) | 57 (54.81) | 34 (47.22) | 0.322 |
Postbronchodilator FEV1% predicted, % | 83.09 ± 16.47 (79.89–86.30) | 73.32 ± 22.94 (67.93–78.71) | 0.006 |
LM scores | 9.00 (6.00, 15.75) | 11.50 (7.25, 18.00) | 0.044 |
Smith scores of bronchiectasis | 7.56 ± 3.46 (6.75–8.37) | ||
Bhalla scores of bronchiectasis | 3.97 ± 1.50 (3.62–4.32) |
Coexistence of bronchiectasis correlates with disease severity in asthma-CRS patients
Variables | Bronchiectasis: logistic regression | ||
---|---|---|---|
OR | 95% CI | P value | |
NPs | 2.79 | 1.43 to 5.46 | 0.003 |
≥ 1 severe exacerbation of asthma in the last 12 months | 2.14 | 1.02 to 4.51 | 0.045 |
Peripheral blood eosinophil counts | 2.60 | 1.19 to 5.67 | 0.016 |
Postbronchodilator FEV1% predicted | 0.98 | 0.96 to 1.00 | 0.039 |
Items | Cutoff value | Sensitivity (%) | Specificity (%) | Youden index |
---|---|---|---|---|
postbronchodilator FEV1% predicted, % | 71.40 | 51.39 | 79.81 | 0.31 |
peripheral blood eosinophil counts, × 109/L | 0.60 | 41.67 | 77.88 | 0.20 |
combined model | 0.33 | 72.22 | 70.19 | 0.42 |
Extent and severity of bronchiectasis predict a more severe asthma-CRS subset
Variables | Smith Score | ||
---|---|---|---|
r | 95% CI | P value | |
Male sex | 0.04 | − 1.53 to 1.62 | 0.955 |
Age | 0.01 | − 0.05 to 0.07 | 0.760 |
BMI | − 0.18 | − 0.35 to 0.00 | 0.049 |
Positive smoking statusa | 0.90 | − 0.75 to 2.56 | 0.280 |
Smoking indexb | 0.19 | − 0.23 to 0.59 | 0.367 |
Duration of asthma | 0.01 | − 0.04 to 0.06 | 0.620 |
NPs | 1.35 | − 0.21 to 2.90 | 0.088 |
Prior sinus surgery | 0.22 | − 1.60 to 2.04 | 0.811 |
Allergic rhinitis | − 0.37 | − 2.06 to 1.31 | 0.662 |
Atopic dermatitis | − 1.75 | − 5.67 to 2.16 | 0.375 |
Gastroesophageal reflux disease | − 0.12 | − 3.21 to 2.98 | 0.941 |
ICS dose (fluticasone equivalent) | 0.00 | 0.00 to 0.00 | 0.812 |
Severe asthma | 0.82 | − 1.10 to 2.75 | 0.397 |
≥ 1 severe exacerbation of asthma in the last 12 months | 1.14 | − 0.43 to 2.70 | 0.153 |
≥ 1 pneumonia in the last 12 months | 1.40 | − 0.23 to 3.04 | 0.091 |
Peripheral blood eosinophil count | 0.86 | − 0.33 to 2.05 | 0.153 |
FeNO | 0.01 | − 0.01 to 0.03 | 0.274 |
Total IgE | 0.00 | 0.00 to 0.00 | 0.476 |
Atopy | − 0.98 | − 2.54 to 0.58 | 0.214 |
postbronchodilator FEV1% predicted | − 0.03 | − 0.07 to 0.00 | 0.051 |
LM scores | 0.10 | − 0.02 to 0.22 | 0.117 |
Variables | Bhalla score | ||
---|---|---|---|
r | 95% CI | P value | |
Male sex | 0.19 | − 0.54 to 0.92 | 0.602 |
Age | 0.01 | − 0.01 to 0.04 | 0.368 |
BMI | − 0.09 | − 0.17 to − 0.01 | 0.035 |
Positive smoking statusa | 0.75 | 0.00 to 1.50 | 0.050 |
Smoking indexb | 0.08 | − 0.12 to 0.27 | 0.429 |
Duration of asthma | − 0.00 | − 0.03 to 0.02 | 0.811 |
NPs | 0.81 | 0.10 to 1.51 | 0.026 |
Prior sinus surgery | 0.02 | − 0.82 to 0.86 | 0.965 |
Allergic rhinitis | 0.06 | − 0.72 to 0.84 | 0.876 |
Atopic dermatitis | − 1.09 | − 2.88 to 0.71 | 0.232 |
Gastroesophageal reflux disease | − 0.69 | − 2.11 to 0.73 | 0.335 |
ICS dose (fluticasone equivalent) | 0.00 | − 0.00 to 0.00 | 0.468 |
Severe asthma | 0.62 | − 0.26 to 1.50 | 0.164 |
≥ 1 severe exacerbation of asthma in the last 12 months | 0.27 | − 0.46 to 1.00 | 0.469 |
≥ 1 pneumonia in the last 12 months | 0.50 | − 0.26 to 1.26 | 0.194 |
Peripheral blood eosinophil counts | 0.19 | − 0.36 to 0.74 | 0.493 |
FeNO | 0.01 | 0.00 to 0.02 | 0.044 |
Total IgE | 0.00 | 0.00 to 0.00 | 0.468 |
Atopy | − 0.30 | − 1.03 to 0.42 | 0.408 |
Postbronchodilator FEV1% predicted | − 0.02 | − 0.03 to 0.00 | 0.045 |
LM scores | 0.05 | 0.00 to 0.11 | 0.060 |
Variables | Smith score: multivariate linear regression | ||
---|---|---|---|
β coefficients | 95% CI | P value | |
NPs | 1.74 | 0.25 to 3.24 | 0.023 |
Postbronchodilator FEV1% predicted | − 0.04 | − 0.07 to − 0.01 | 0.019 |
BMI | − 0.18 | − 0.34 to − 0.01 | 0.041 |
Variables | Bhalla score: multivariate linear regression | ||
---|---|---|---|
β coefficients | 95% CI | P value | |
NPs | 1.11 | 0.45 to 1.77 | 0.001 |
Postbronchodilator FEV1% predicted | − 0.02 | − 0.03 to − 0.00 | 0.029 |
BMI | − 0.08 | − 0.16 to − 0.01 | 0.032 |
Positive smoking statusa | 0.73 | 0.03 to 1.44 | 0.042 |