Published online: May 8, 2018
Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses that affects up to 10% of the population. Its most recognized manifestation is the chronic symptomatology, such as nasal drainage and facial pressure, that is associated with CRS, and the most dramatic impact that these symptoms have is to decrease quality of life (QOL). It has been well described that a greater burden of CRS symptoms is associated with worsening QOL. More recent work has shown that depressed mood may also impact a patient’s disease perception and therefore impact the degree of QOL decrease that occurs for a given burden of CRS symptomatology.
Recently, in The Journal of Allergy and Clinical Immunology: In Practice, Sedaghat and colleagues studied the ability of depressed mood to modulate the relationship between CRS symptom burden and decreased QOL in a cohort of 610 patients with CRS. They divided the patients into two groups, those with well-controlled symptoms and those with poorly controlled symptoms (based on a cut-off score of a validated questionnaire to quantify CRS symptom burden previously determined by the authors). The authors then studied the association of symptom burden with QOL in the well-controlled and poorly controlled cohorts with a focus on the impact of depressed mood.
Sedaghat and colleagues showed that in the patients with well-controlled symptoms (i.e. low CRS symptom burden), depressed mood was associated with decreased QOL and, as expected, the total CRS symptom burden was also associated with decreased QOL. In the patients with poorly controlled symptoms (i.e. high CRS symptom burden), only depressed mood was associated with decreased QOL but the total CRS symptom burden was not associated with decreased QOL.
This study by Sedaghat and colleagues demonstrates the important role for depressed mood in determining the degree of decreased QOL in patients who experience CRS symptoms. Moreover, the findings of this study importantly suggest a threshold effect for the impact of CRS symptoms on decreased QOL. That total CRS symptom burden does not associate with decreased QOL in patients with poorly controlled symptoms suggests that beyond a well-defined threshold of symptom burden, only the degree to which a patient’s mood is depressed determines the extent to which QOL decreases. In contrast, worsening CRS symptoms no longer have a substantial impact on QOL in these patients. These findings raise the possibility that, in CRS patients with the worst burden of disease and ostensibly the most recalcitrant disease, modulation of depressed mood may serve to improve QOL.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.