Prevalence of bronchiectasis in patients with chronic rhinosinusitis
Published online: August 1, 2021
Chronic rhinosinusitis (CRS) is a common inflammatory condition that affects 6-12% of the population and causes nasal drainage, congestion, facial pressure, and often loss of smell. Although the association between CRS and asthma is well understood, the association of CRS with other lower respiratory conditions such as bronchiectasis is not well established. Bronchiectasis is associated with permanent damage to the lower airways and causes chronic cough with purulent sputum. However, there are limited data characterizing the relationship between CRS and bronchiectasis.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Peters and colleagues aimed to describe the prevalence of non-cystic fibrosis bronchiectasis in patients with CRS and characterize patients with CRS and non-cystic fibrosis bronchiectasis (noted as bronchiectasis going forward).The authors analyzed the medical records of patients with CRS at a large academic center using an automated electronic review system to describe the prevalence of and clinically characterize patients with bronchiectasis. Patients older than 18 were included if they were diagnosed with CRS between January 1, 2002, and December 31, 2012. Of the 25,660 patients identified, 5,557 were selected by stringent criteria and were diagnosed with CRS with or without nasal polyps (NP) by an otolaryngologist or an allergist. The authors also identified 9,604 patients with asthma at their institution during the same time frame. The prevalence of bronchiectasis was identified by 2 different strategies in both groups, first based on ICD9 code and second by the presence of text word, “bronchiectasis” in individuals with chest CT scans. The authors obtained the demographics and clinical characteristics of all patients. Lastly, they determined if patients with CRS and bronchiectasis had a worse outcome after sinus surgery compared with CRS patients without bronchiectasis.
The prevalence of bronchiectasis as assessed by ICD-9 codes was significantly higher in patients with CRS (2.3%) than in patients with asthma (1.7%). Similarly, among patients who had a chest CT scan, the prevalence of bronchiectasis was higher in patients with CRS (24.3% ) than in patients with asthma (19.5%).
In the CRS group, the mean age of patients with bronchiectasis was 53 + 13 years, and the majority of the patients were women. There was no difference in age, sex, or race between CRS patients with or without bronchiectasis. Although the prevalence of asthma was similar between CRS patients with and without bronchiectasis, lung function was lower in patients with CRS and bronchiectasis. The authors also found that patients with CRS and bronchiectasis had a higher prevalence of allergic rhinitis and gastroesophageal reflux disease than patients with CRS without bronchiectasis. Finally, in contrast to CRS patients without bronchiectasis, patients with CRS and bronchiectasis did not have a reduction in antibiotic courses after sinus surgery, suggesting that bronchiectasis may be predictive of more severe sinus disease. This study suggests clinicians treating patients with CRS need to be aware of coexistent bronchiectasis and screen for bronchiectasis if clinically indicated.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.