Rhinosinusitis without nasal polyps an important comorbidity of COPD

Chronic obstructive pulmonary disease (COPD) patients who have concomitant rhinosinusitis without nasal polyps (RSsNP) face more psychological issues, higher COPD symptom burden, and poorer overall quality of life (QoL), according to a study.

“We found that RSsNP in COPD has clinical relevance and support previous studies that have suggested that RSsNP should be recognized as a comorbidity in patients with COPD,” the investigators said.

In the present study, severe and very severe degree of airflow obstruction (GOLD 3-4) was more prevalent among COPD patients with vs without RSsNP (56.5 percent vs 38.6 percent). [Respir Med 2021;doi:10.1016/j.rmed.2021.106661]

Disease-specific health-related QoL (HRQoL) was poorer among those with vs without RSsNP, as indicated by a higher sinonasal outcome test-22 (SNOT-22) total score (14.67 points, 95 percent CI, 7.06–22.28; p<0.001) and psychological subscale score (3.24 points, 95 percent CI, 0.37–6.11; p=0.03), St. Georges Respiratory Questionnaire (SGRQ) symptom score (13.08 points, 95 percent CI, 2.73–23.4; p=0.014), and COPD Assessment Test (CAT) score (4.41 points, 95 percent CI, 1.15–7.66; p=0.009).

More specifically, RSsNP was associated with sadness, embarrassment, frustration/irritability, fatigue, and reduced concentration and productivity.

“Conversely, we did not find that the increased sinonasal burden of RSsNP affected sleep quality in these patients, [which indicates] that the sleep disturbance that is known to be present in patients with COPD was not exacerbated by the symptoms of RSsNP,” according to the investigators. [Int J Chron Obstruct Pulmon Dis 2020;15:1015-1037; Respir Res 2017;18:67]

Finally, while COPD patients already had worse generic HRQoL than non-COPD controls, concomitant RSsNP further contributed to poorer physical functioning, general health, vitality, and physical component summary.

Manifesting as chronic nasal symptoms, rhinosinusitis has been described as the most prevalent underrecognized comorbidity of COPD in a review from 2015. But to date, the investigators noted that the respiratory condition is still not recognized as such.

In the current study, the disease-specific HRQoL parameters of total mean SGRQ score, CAT score, and total SNOT-22 score were much less favourable among COPD patients with vs without RSsNP. Furthermore, the difference of 6.3 points, 4.4 points, and 14.7 points in the respective scores exceed the minimally clinically important difference that is required to show efficacy in an intervention study. This suggests that diagnosis and treatment of RSsNP may contribute to a clinically meaningful change in the disease-specific HRQoL in COPD, according to the investigators. [https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf; Lancet Respir Med 2014;2:195-203; Clin Otolaryngol 2018;43:1328-1334]

“Not all comorbid diseases have clinical relevance, and focus should be on detecting those that are associated with important outcomes in COPD, such as HRQoL,” they said. [Int J Chron Obstruct Pulmon Dis 2015;10:1331-1341; https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf; Clin Chest Med 2020;41:405-419]

“The present study provides additional evidence that the united airway disease concept may also be applicable for COPD and rhinosinusitis. It is thus important to diagnose and manage RSsNP in COPD,” the investigators pointed out. [Respir Med 2020;171:106092; Thorax 2010;65:85-90]

The study had several limitations, including the failure to examine comorbidities that potentially could contribute to poorer HRQoL in patients with COPD and the cross-sectional study design that precluded drawing conclusions on the direction of influence of the associations between RSsNP and HRQoL in COPD.

Also, the participants in the present study were limited to patients of white Caucasian descent and those without concomitant asthma, making the generalizability of the results to other populations limited.