Aspirin-Exacerbated Respiratory Disease: Association Between Patient-Reported Sinus and Asthma Morbidity

Abstract

Background: The association between sinonasal and pulmonary symptoms in aspirin-exacerbated respiratory disease is not fully established.

Objective: To characterize sinonasal and asthma symptomatology, and to determine whether reported sinonasal symptoms predict asthma severity.

Methods: Prospectively collected data from an aspirin-exacerbated respiratory disease registry cohort were included from 2013 to 2018. Sinonasal symptomatology measured by Sino-Nasal Outcomes Test (SNOT) 22-item total scores was used as the predictor variable, with Asthma Control Test (ACT) scores and percent predicted FEV₁ (FEV₁% predicted) as primary outcomes. All instances of paired data on the same date were used. ACT score was also evaluated with FEV₁% predicted as the outcome. Mixed effects regression was completed.

Results: From 1065 aspirin-exacerbated respiratory disease registry subjects (mean age, 48.1 ± 12.8 years; 68.0% females, 29.8% males), mean SNOT-22 score was 42.3 ± 24.12 (n = 1307 observations from 869 subjects), mean ACT score was 19.4 ± 5.2 (n = 1511 observations from 931 subjects), and mean FEV₁% predicted was 82.8 ± 19.6 (n = 777 observations from 307 subjects). SNOT-22 score significantly predicted ACT scores (P < .0001, 1185 paired observations from 845 subjects) and FEV₁% predicted (P = .018, 485 observations from 246 subjects). Any 10-point increase in SNOT-22 score was associated with a 0.87-point decrease in ACT score and a 0.75% decrease in FEV₁% predicted. Any 1-point increase in ACT score was associated with a 1.0% increase in FEV₁% predicted (P < .0001, 616 observations from 269 subjects). The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose.

Conclusions: SNOT-22 scores significantly predict ACT scores and FEV₁% predicted, and ACT scores significantly predict FEV₁% predicted. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity.

Keywords: Aspirin-exacerbated respiratory disease; Asthma; Chronic rhinosinusitis; Outcomes; Patient-reported outcomes; Sinusitis; Spirometry.