Asthma, rhinitis, other respiratory diseasesRhinosinusitis in severe asthma
Abstract
Background: Chronic rhinosinusitis is a common comorbidity of asthma. However, sinonasal involvement in severe steroid-dependent asthma is still undefined. Objective: The aim of the study was to evaluate chronic rhinosinusitis in 35 patients with severe steroid-dependent asthma by using a clinical score and coronal computed tomography (CT) scanning. Methods: Thirty-five subjects (16 female subjects) with severe asthma requiring daily doses of oral corticosteroids were compared with 34 patients (19 female patients) with mild-to-moderate asthma. Sinonasal involvement was studied by using clinical and CT scores. Airflow obstruction, therapy requirement, and asthma triggering factors were carefully assessed. Results: The proportion of patients with symptoms of rhinosinusitis was similar in both groups of asthmatic subjects (74% in patients with severe steroid-dependent asthma and 70% in patients with mild-to-moderate asthma). All subjects with steroid-dependent asthma versus 88% of subjects with mild-to-moderate asthma had abnormal CT scan results. The clinical (P < .05) and CT scan (P < .0005) severity scores were higher in the subjects with severe steroid-dependent asthma. In both groups the CT scan scores were correlated to the clinical scores (P < .0001 and P < .006), but only in the mild-to-moderate group were both scores correlated with high significance (P < .002 and P < .0005) to the absolute number of blood eosinophils. Conclusion: Frequency of rhinosinusitis in patients with mild-to-moderate or severe steroid-dependent asthma is similar; however, sinonasal involvement, as evaluated by clinical symptoms and CT scan imaging, is significantly greater in the patients with severe steroid-dependent asthma than in those with mild-to-moderate asthma. (J Allergy Clin Immunol 2001;107:73-80.)
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The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project
2024, Journal of Allergy and Clinical Immunology: GlobalSevere asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown.
We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia.
Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ).
Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001.
The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.
Rethinking the relationships between chronic rhinosinusitis and asthma severity
2023, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryPrevious authors have endorsed the need for prospective studies on the effect of treatment of chronic rhinosinusitis on asthma outcomes. Although common pathophysiology for asthma and chronic rhinosinusitis (CRS) has been suggested with the unified airway theory, there is limited data to support the claim and our study does not support the theory.
This case-control study involved adult patients with a primary diagnosis of asthma in 2019 who were identified from the electronic medical records and divided into those with and without an associated CRS diagnosis. For each asthma encounter, the asthma severity classification, oral corticosteroid (OCS) use and oxygen saturation scores were tabulated and compared between asthma patients with CRS versus control patients after 1:1 matching on age and sex.
We determined the association between asthma and chronic rhinosinusitis when evaluating proxies for disease severity: oral corticosteroid use, average oxygen saturation and minimum oxygen saturation. We identified 1321 clinical encounters for asthma associated with CRS and 1321 control encounters for asthma without CRS.
OCS prescription rates at the asthma encounter were not statistically different between the groups (15.3 % and 14.6 %, respectively; p = 0.623). Asthma severity classification was higher in those with CRS versus those without (38.9 % and 25.7 % classified as severe, respectively; p < 0.001).
We identified 637 asthma with CRS and 637 matched control patients. There was no significant difference in mean recorded O2 saturations between asthma patients with CRS versus control patients (mean O2 saturations, 97.2 % and 97.3 %, respectively; p = 0.816) nor in minimum oxygen saturation (96.8 % and 97.0 %, respectively; p = 0.115).
Among patients with a primary diagnosis of asthma an increasing severity of asthma classification was significantly associated with an associated diagnosis of CRS. In contradistinction, the presence of CRS comorbidity in asthma patients was not associated with increased OCS use for asthma. Similarly, average oxygen saturation and minimum oxygen saturation did not seem differ according to CRS comorbidity. Our study does not support the unified airway theory that suggests a causative relationship between the upper and lower airway.
Diagnosis and management of rhinitis and rhinosinusitis
2022, Allergic and Immunologic Diseases: A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic DiseasesRhinitis and rhinosinusitis (RS) are prevalent disease processes that afflict many patients on a regular basis and, therefore it is important for clinicians across all subspecialties to become familiar with the terminology utilized in these various disease processes. There exist key diagnostic differences, both clinically and radiologically, for allergic rhinitis, nonallergic rhinitis, acute RS, recurrent acute RS, and chronic RS (CRS). It is important that the treating clinician can differentiate these findings from noninflammatory disease processes, that is intranasal tumors. The workup and management of each of these disease processes can and should proceed in a systematic fashion. Medical therapies, both topical and systemic, should be optimized prior to consideration of surgical intervention. The medical management of many of these disease processes continue to evolve, now with options including enhanced delivery systems (i.e., exhalation delivery system with fluticasone) and high-volume, high-pressure delivery of topical medications. One must recognize, for example, that CRS is a syndrome with numerous etiologies, oftentimes requiring both surgical intervention and long-term medical management in order to achieve an appropriate outcome. From a surgical perspective, it is important to recognize that there exists a spectrum of endoscopic sinus surgery. Depending on the underlying disease process, surgical intervention may range from limited dissection to complete endoscopic sinus surgery. Difficult to treat disease requires close cooperation between otolaryngologist and allergist, close familiarity with endoscopic techniques and endoscopic findings, and ongoing medical therapy even after surgical intervention. However, until such time as COVID-19 immunization or natural immunity is achieved, nasal endoscopy is felt to provide particular risks due to the high viral load in the nose.
Evaluation of olfactory dysfunction to estimate the presence of eosinophilic chronic rhinosinusitis in patients with asthma
2021, Respiratory InvestigationEosinophilic chronic rhinosinusitis (ECRS) is often complicated by asthma and can be difficult to diagnose. This study aimed to clarify the usefulness of the self-administered odor questionnaire (SAOQ) and visual analog scale (VAS) to identify olfactory disorders in patients with asthma.
This retrospective study was conducted on patients with asthma who were referred to the Otolaryngology clinic between May and September 2018. The treatment step of asthma, asthma control test (ACT), pulmonary function test, peripheral blood eosinophils, and fractional exhaled nitric oxide (FeNO) were analyzed. ECRS was diagnosed based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study score. Olfactory dysfunction was evaluated using the SAOQ and VAS for olfactory disorders.
The study included 56 patients (18 males and 38 females), who were divided into two groups; those with ECRS (n = 18) and those without ECRS (n = 38). Age, sex, treatment step, ACT score, and pulmonary function were not significantly different between the groups. The ECRS group had a significantly higher FeNO value (89.1 ppb vs. 39.1 ppb) and a significantly lower SAOQ score (40.1% vs. 96.1%). The area under the receiver operating characteristic curve for the efficacy of ECRS diagnosis was 0.88, 0.889, 0.799, and 0.757 for SAOQ, VAS, blood eosinophil count, and FeNO, respectively.
The SAOQ and VAS scores were useful tools that presented similar results to the blood eosinophil count and FeNO, and may help to improve the diagnosis of ECRS in patients with asthma.
Strategies for pulmonary delivery of drugs
2019, Drug Delivery SystemsIn recent years the pulmonary route of drug delivery has gained huge scientific and industrial interest and is explored widely for local and systemic delivery of pharmaceuticals to treat pulmonary and nonpulmonary diseases. The high permeability and surface area of lung provide an alternative route for drug delivery in ailments such as asthma, chronic obstructive pulmonary disease, and diabetes. In the pulmonary route the successful administration of drugs needs a proper balance between drug formulation, the inhalation device, and the patients. This chapter presents a holistic overview of various features of drug delivery to the lungs. Besides, it also includes the physiology of the respiratory system with its associated disorders along with different methodologies to deliver drugs and recent improvement in the pulmonary drug delivery system. In addition the chapter also gives a detailed focus on mechanisms by which pulmonary drugs are administered as well as their compatibility with the excipients used. It entails the inhalation drugs products such as pressurized metered-dose inhaler, nebulizer, and dry powder inhaler that are commercially available in global markets. Also, an update for the development of inhalers with their practical considerations has been discussed along with the regulatory considerations of European Medicines Agency, Food and Drug Administration, and Health Canada. The chapter provides an overall concept on pulmonary drug delivery, which helps pharmaceutical scientist to minimize the technical and clinical gap for drug(s) administration to lungs.
Sinus Infections, Inflammation, and Asthma
2019, Immunology and Allergy Clinics of North America