What illnesses precede a diagnosis of Chronic Rhinosinusitis?
Published Online: March 29, 2103
Chronic Rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that manifests clinically in two forms, one with nasal polyps (CRSwNP) and another without (CRSsNP). Despite significant prevalence, the epidemiology of chronic rhinosinusitis (CRS) has been underexplored at the population level with most prior studies utilizing tertiary care patient populations or data from single encounters. Even the incidence of this disease was previously unknown, and most studies generally utilized patient recall for past medical history.
In a new study recently published in The Journal of Allergy and Clinical Immunology (JACI), Tan et al conducted a population-based, retrospective, case-control study using the electronic health records (EHR) of primary care patients of the Geisinger Clinic. The Geisinger Clinic serves a representative primary-care population spanning a large geographical area in central Pennsylvania. It has amassed 10 years of longitudinal EHR data beginning in 2001, facilitating longitudinal studies of diseases. A total of 8,118 patients coded with a new diagnosis of CRS between 2007 and 2009 were compared an equal number of age, gender, and visit-matched patients without a CRS diagnosis. Coded diagnoses, medication use, and visit frequency preceding the CRS diagnosis were then analyzed.
The authors estimate the incidence of CRSwNP and CRSsNP was 83 and 1,048 per 100,000 patient years, respectively. They further found profound elevations of both upper and lower airway-related conditions preceding a CRS diagnosis. These data lend strong support for the notion of a unified airway linked by common inflammatory and physiologic mechanisms. Outside the airway, the authors also found elevated rates of gastroesophageal reflux, conjunctivitis, urinary tract infections, and atopic dermatitis that were more significant in the CRSsNP due to the larger size of the CRSsNP group. Even 7-24 months prior to their diagnosis, CRS patients were receiving more antibiotics and seeing their physicians more frequently. Their physicians utilized guideline recommended diagnostic modalities (nasal endoscopy and/or sinus CT scan) in less then 1/3 of cases.
These data provide critical information regarding the epidemiology of CRS, a common but debilitating condition. Additionally, it provides an estimate of the magnitude that various pre-morbid illnesses modify the likelihood of subsequently developing CRS and provide means to identify at-risk populations. Finally, it lends support to the notion that a unified airway and epithelial barrier dysfunction may play a role in the pathogenesis of CRS. These data also provide insights on how CRS patients are being diagnosed and demonstrates that nasal endoscopy and/or a sinus CT scan for the diagnosis of CRS are still highly underutilized in the community.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.