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Erschienen in: Current Allergy and Asthma Reports 3/2020

01.03.2020 | Rhinosinusitis (J Mullol, Section Editor)

Evolving Rhinology: Understanding the Burden of Chronic Rhinosinusitis Today, Tomorrow, and Beyond

verfasst von: Michael T. Yim, Richard R. Orlandi

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 3/2020

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Abstract

Purpose of Review

To improve our appreciation of the burden of chronic rhinosinusitis (CRS) and to understand better how to ease that burden.

Recent Findings

The burden of CRS is high. At an individual level, this burden is due to rhinologic symptoms as well as more systemic symptoms. At a societal level, the indirect costs of CRS, mostly due to reduced productivity, are higher than the direct costs. Surgical treatment has been found to be effective in addressing both the individual and societal burdens. Endotyping is just beginning to usher in the potential for personalized, precision treatments in CRS.

Summary

We understand much about the burden of CRS but more remains to be learned, especially as newer expensive treatments become available. By appreciating the high burden of CRS, we can fulfill our mission to effectively lift that burden.
Literatur
1.
Zurück zum Zitat Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl 1):S22–209.PubMed Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl 1):S22–209.PubMed
2.
Zurück zum Zitat Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1–464. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2020.  Rhinology. 2020;58(Suppl S29):1–464.
3.
Zurück zum Zitat Soler ZM, Hyer JM, Ramakrishnan V, Smith TL, Mace J, Rudmik L, et al. Identification of chronic rhinosinusitis phenotypes using cluster analysis. Int Forum Allergy Rhinol. 2015;5(5):399–407.CrossRef Soler ZM, Hyer JM, Ramakrishnan V, Smith TL, Mace J, Rudmik L, et al. Identification of chronic rhinosinusitis phenotypes using cluster analysis. Int Forum Allergy Rhinol. 2015;5(5):399–407.CrossRef
4.
Zurück zum Zitat Workman AD, Kohanski MA, Cohen NA. Biomarkers in chronic rhinosinusitis with nasal polyps. Immunol Allergy Clin N Am. 2018;38(4):679–92.CrossRef Workman AD, Kohanski MA, Cohen NA. Biomarkers in chronic rhinosinusitis with nasal polyps. Immunol Allergy Clin N Am. 2018;38(4):679–92.CrossRef
5.
Zurück zum Zitat •• Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449–56 e4. A leap forward in our understanding of endotypes based on inflammatory profiles. CrossRef •• Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449–56 e4. A leap forward in our understanding of endotypes based on inflammatory profiles. CrossRef
6.
Zurück zum Zitat Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, et al. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - a EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy. 2017;72(9):1297–305.CrossRef Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, et al. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - a EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy. 2017;72(9):1297–305.CrossRef
7.
Zurück zum Zitat DeConde AS, Soler ZM. Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy. 2016;30(2):134–9.CrossRef DeConde AS, Soler ZM. Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy. 2016;30(2):134–9.CrossRef
8.
Zurück zum Zitat Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol. 2015;136(6):1431–40.CrossRef Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol. 2015;136(6):1431–40.CrossRef
9.
Zurück zum Zitat Smith KA, Orlandi RR, Rudmik L. Cost of adult chronic rhinosinusitis: a systematic review. Laryngoscope. 2015;125(7):1547–56.CrossRef Smith KA, Orlandi RR, Rudmik L. Cost of adult chronic rhinosinusitis: a systematic review. Laryngoscope. 2015;125(7):1547–56.CrossRef
10.
Zurück zum Zitat •• Rudmik L. Economics of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2017;17(4):20. An excellent summary of our current understanding of the costs of CRS. CrossRef •• Rudmik L. Economics of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2017;17(4):20. An excellent summary of our current understanding of the costs of CRS. CrossRef
11.
Zurück zum Zitat Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014;124(9):2007–12.CrossRef Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014;124(9):2007–12.CrossRef
12.
Zurück zum Zitat Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 2004;193:3–5.CrossRef Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 2004;193:3–5.CrossRef
13.
Zurück zum Zitat Bhattacharyya N. Functional limitations and workdays lost associated with chronic rhinosinusitis and allergic rhinitis. Am J Rhinol Allergy. 2012;26(2):120–2.CrossRef Bhattacharyya N. Functional limitations and workdays lost associated with chronic rhinosinusitis and allergic rhinitis. Am J Rhinol Allergy. 2012;26(2):120–2.CrossRef
14.
Zurück zum Zitat Smith KA, Rudmik L. Impact of continued medical therapy in patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(1):34–8.CrossRef Smith KA, Rudmik L. Impact of continued medical therapy in patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(1):34–8.CrossRef
15.
Zurück zum Zitat Stankiewicz J, Tami T, Truitt T, Atkins J, Winegar B, Cink P, et al. Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum. Int Forum Allergy Rhinol. 2011;1(1):38–45.CrossRef Stankiewicz J, Tami T, Truitt T, Atkins J, Winegar B, Cink P, et al. Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum. Int Forum Allergy Rhinol. 2011;1(1):38–45.CrossRef
16.
Zurück zum Zitat Tarasidis GS, DeConde AS, Mace JC, Ashby S, Smith TL, Orlandi RR, et al. Cognitive dysfunction associated with pain and quality of life in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(11):1004–9.CrossRef Tarasidis GS, DeConde AS, Mace JC, Ashby S, Smith TL, Orlandi RR, et al. Cognitive dysfunction associated with pain and quality of life in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(11):1004–9.CrossRef
17.
Zurück zum Zitat Chowdhury NI, Mace JC, Smith TL, Rudmik L. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis. Laryngoscope. 2018;128(1):23–30.CrossRef Chowdhury NI, Mace JC, Smith TL, Rudmik L. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis. Laryngoscope. 2018;128(1):23–30.CrossRef
18.
Zurück zum Zitat • Smith KA, Ashby S, Orlandi RR, Oakley G, Alt JA. The price of pain in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018. https://doi.org/10.1002/alr.22128. This article demonstrates an association between pain, an often overlooked symptoms in CRS due to its poor diagnostic specificity, and productivity losses in CRS. CrossRef • Smith KA, Ashby S, Orlandi RR, Oakley G, Alt JA. The price of pain in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018. https://​doi.​org/​10.​1002/​alr.​22128. This article demonstrates an association between pain, an often overlooked symptoms in CRS due to its poor diagnostic specificity, and productivity losses in CRS. CrossRef
19.
Zurück zum Zitat Park DY, Lee EJ, Kim JH, Kim YS, Jung CM, Kim KS. Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies. BMJ Open. 2015;5(12):e009541.CrossRef Park DY, Lee EJ, Kim JH, Kim YS, Jung CM, Kim KS. Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies. BMJ Open. 2015;5(12):e009541.CrossRef
20.
Zurück zum Zitat Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011;121(12):2672–8.CrossRef Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011;121(12):2672–8.CrossRef
21.
Zurück zum Zitat Hoehle LP, Phillips KM, Bergmark RW, Caradonna DS, Gray ST, Sedaghat AR. Symptoms of chronic rhinosinusitis differentially impact general health-related quality of life. Rhinology. 2016;54(4):316–22.CrossRef Hoehle LP, Phillips KM, Bergmark RW, Caradonna DS, Gray ST, Sedaghat AR. Symptoms of chronic rhinosinusitis differentially impact general health-related quality of life. Rhinology. 2016;54(4):316–22.CrossRef
22.
Zurück zum Zitat • Bachert C, Hellings PW, Mullol J, Hamilos DL, Gevaert P, Naclerio RM, et al. Dupilumab improves health-related quality of life in patients with chronic rhinosinusitis with nasal polyposis. Allergy. 2020;75(1):148–57. An article examining the effect of monoclonal antibiody “biologic” therapy, in this case focusing on patient-reported outcome measures. CrossRef • Bachert C, Hellings PW, Mullol J, Hamilos DL, Gevaert P, Naclerio RM, et al. Dupilumab improves health-related quality of life in patients with chronic rhinosinusitis with nasal polyposis. Allergy. 2020;75(1):148–57. An article examining the effect of monoclonal antibiody “biologic” therapy, in this case focusing on patient-reported outcome measures. CrossRef
23.
Zurück zum Zitat Fine PG. Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med. 2011;12(7):996–1004.CrossRef Fine PG. Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med. 2011;12(7):996–1004.CrossRef
24.
Zurück zum Zitat DeConde AS, Mace JC, Ashby S, Smith TL, Orlandi RR, Alt JA. Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments. Int Forum Allergy Rhinol. 2015;5(8):682–90.CrossRef DeConde AS, Mace JC, Ashby S, Smith TL, Orlandi RR, Alt JA. Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments. Int Forum Allergy Rhinol. 2015;5(8):682–90.CrossRef
25.
Zurück zum Zitat Cox DR, Ashby S, DeConde AS, Mace JC, Orlandi RR, Smith TL, et al. Dyad of pain and depression in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(3):308–14.CrossRef Cox DR, Ashby S, DeConde AS, Mace JC, Orlandi RR, Smith TL, et al. Dyad of pain and depression in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(3):308–14.CrossRef
26.
Zurück zum Zitat Cox DR, Ashby S, Mace JC, DelGaudio JM, Smith TL, Orlandi RR, et al. The pain-depression dyad and the association with sleep dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017;7(1):56–63.CrossRef Cox DR, Ashby S, Mace JC, DelGaudio JM, Smith TL, Orlandi RR, et al. The pain-depression dyad and the association with sleep dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017;7(1):56–63.CrossRef
27.
Zurück zum Zitat Schlosser RJ, Gage SE, Kohli P, Soler ZM. Burden of illness: a systematic review of depression in chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(4):250–6.CrossRef Schlosser RJ, Gage SE, Kohli P, Soler ZM. Burden of illness: a systematic review of depression in chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(4):250–6.CrossRef
28.
Zurück zum Zitat Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123(10):2364–70.PubMedPubMedCentral Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123(10):2364–70.PubMedPubMedCentral
29.
Zurück zum Zitat Alt JA, Ramakrishnan VR, Platt MP, Schlosser RJ, Storck T, Soler ZM. Impact of chronic rhinosinusitis on sleep: a controlled clinical study. Int Forum Allergy Rhinol. 2019;9(1):16–22.CrossRef Alt JA, Ramakrishnan VR, Platt MP, Schlosser RJ, Storck T, Soler ZM. Impact of chronic rhinosinusitis on sleep: a controlled clinical study. Int Forum Allergy Rhinol. 2019;9(1):16–22.CrossRef
30.
Zurück zum Zitat Chester AC, Sindwani R, Smith TL, Bhattacharyya N. Fatigue improvement following endoscopic sinus surgery: a systematic review and meta-analysis. Laryngoscope. 2008;118(4):730–9.CrossRef Chester AC, Sindwani R, Smith TL, Bhattacharyya N. Fatigue improvement following endoscopic sinus surgery: a systematic review and meta-analysis. Laryngoscope. 2008;118(4):730–9.CrossRef
31.
Zurück zum Zitat Smith KA, Smith TL, Mace JC, Rudmik L. Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(10):823–7.CrossRef Smith KA, Smith TL, Mace JC, Rudmik L. Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(10):823–7.CrossRef
32.
Zurück zum Zitat Smith TL, Kern R, Palmer JN, Schlosser R, Chandra RK, Chiu AG, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2013;3(1):4–9.CrossRef Smith TL, Kern R, Palmer JN, Schlosser R, Chandra RK, Chiu AG, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2013;3(1):4–9.CrossRef
33.
Zurück zum Zitat •• Patel ZM, Thamboo A, Rudmik L, Nayak JV, Smith TL, Hwang PH. Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol. 2017;7(2):119–27. A thorough analysis of outcomes evidence regarding the relative efficacy of surgery compared to continued medical management, demonstrating the relative superiority of a surgical strategy in these patients. CrossRef •• Patel ZM, Thamboo A, Rudmik L, Nayak JV, Smith TL, Hwang PH. Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol. 2017;7(2):119–27. A thorough analysis of outcomes evidence regarding the relative efficacy of surgery compared to continued medical management, demonstrating the relative superiority of a surgical strategy in these patients. CrossRef
34.
Zurück zum Zitat • Rudmik L, Soler ZM, Mace JC, Schlosser RJ, Smith TL. Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope. 2015;125(1):25–32. A rigorous economic analysis of endoscopic sinus surgery that demonstrates the relative supeiority of sinus surgery depending on quality adjusted life years and willingness to pay thresholds. CrossRef • Rudmik L, Soler ZM, Mace JC, Schlosser RJ, Smith TL. Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope. 2015;125(1):25–32. A rigorous economic analysis of endoscopic sinus surgery that demonstrates the relative supeiority of sinus surgery depending on quality adjusted life years and willingness to pay thresholds. CrossRef
35.
Zurück zum Zitat • Scangas GA, Remenschneider AK, Su BM, Shrime MG, Metson R. Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyposis. Laryngoscope. 2017;127(1):29–37. Another rigorous economic analysis of sinus surgery, using slightly different economic assumptions compared to Rudmik, et al (2015). CrossRef • Scangas GA, Remenschneider AK, Su BM, Shrime MG, Metson R. Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyposis. Laryngoscope. 2017;127(1):29–37. Another rigorous economic analysis of sinus surgery, using slightly different economic assumptions compared to Rudmik, et al (2015). CrossRef
36.
Zurück zum Zitat Beswick DM, Mace JC, Rudmik L, Soler ZM, DeConde AS, Smith TL. Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain. Int Forum Allergy Rhinol. 2018;8(12):1395–405.CrossRef Beswick DM, Mace JC, Rudmik L, Soler ZM, DeConde AS, Smith TL. Productivity changes following medical and surgical treatment of chronic rhinosinusitis by symptom domain. Int Forum Allergy Rhinol. 2018;8(12):1395–405.CrossRef
37.
Zurück zum Zitat • Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet. 2019;394(10209):1638–50. Early evidence that monoclonal antibody “biologic” therapy could have a significant impact on current and future treatment of CRS, with a focus on endoscopic and symptomatic findings. • Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet. 2019;394(10209):1638–50. Early evidence that monoclonal antibody “biologic” therapy could have a significant impact on current and future treatment of CRS, with a focus on endoscopic and symptomatic findings.
Metadaten
Titel
Evolving Rhinology: Understanding the Burden of Chronic Rhinosinusitis Today, Tomorrow, and Beyond
verfasst von
Michael T. Yim
Richard R. Orlandi
Publikationsdatum
01.03.2020
Verlag
Springer US
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 3/2020
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-020-00904-w

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