Figure 1. Frequency of sinonasal disease in asthmatic patients José Antonio Castillo (1), César Picado (2) Vicente Plaza (3), Gustavo Rodrigo (4), Berta.

Presentación del tema: "Figure 1. Frequency of sinonasal disease in asthmatic patients José Antonio Castillo (1), César Picado (2) Vicente Plaza (3), Gustavo Rodrigo (4), Berta."— Transcripción de la presentación:

1 Figure 1. Frequency of sinonasal disease in asthmatic patients José Antonio Castillo (1), César Picado (2) Vicente Plaza (3), Gustavo Rodrigo (4), Berta Juliá (5), Joaquim Mullol (6); and IRIS-ASMA Group (7) (1) Institut Universitari Dexeus, Neumología, Barcelona; (2) Hospital Clínic, Neumología, Barcelona; (3) Hospital Sta. Creu i Sant Pau, Neumología, Barcelona; (4) Hospital de las Fuerzas Armadas, Montevideo (Uruguay); (5) Departamento Médico MSD-España, Madrid; (6) Immunoal.lèrgia Respiratòria Clínica i Experimental, IDIBAPS & Unitat de Rinologia i Clínica de l’Olfacte, Servei d’ORL, Hospital Clínic, Barcelona. Abstract nº 249 BACKGROUND Rhinitis and chronic rhinosinusitis (CRS) are upper airway inflammatory diseases frequently associated with asthma. International guidelines for rhinitis (ARIA) and rhinosinusitis (EPOS) recommend, in addition to nasal endoscopy, CT scan, and skin prick test (SPT), the use of sinonasal symptoms by clinical history to define rhinitis and CRS. OBJECTIVES To assess the sinonasal disease prevalence and the reliability of sinonasal symptoms to discriminate between rhinitis, allergic or non- allergic, and CRS, with or without nasal polyps, in asthma patients. (7) IRIS-ASMA investigator group Spain: Almonacid C, Domínguez EM (H.U. de Guadalajara); Arenas AP, Bujalance C, Gutiérrez J (H. Reina Sofía, Córdoba); G. Barcala FJ, Arán I, Cabanas ER (H.C.U. Santiago de Compostela y Hospital de Pontevedra); Castillo JA, Vila S, de Frías B (Institut Universitari Dexeus, Barcelona); Cisneros C, Fernández I (H. de la Princesa, Madrid); González MV,Bardagí S, Chamizo J (H. de Mataró); Hernando R, Casas X, Vera R (H. de Sant Boi de Llobregat); Ignacio JM, O'Connor C, Pérez F, (H. USP Marbella); López E, Chacón J (H. Virgen de la Salud, Toledo); Marina N, Gómez J (H. Cruces, Baracaldo); Martínez E, Pérez del Valle B (H. de Sagunto); Martínez Rivera C, Pollan C (H. U. Germans Trías, Badalona); Mullol J, Vennera MC, Alobid I, (H. Clínic, Barcelona); Pascual S, Urrutia I, Gómez R (H. Galdakao-Usánsolo); Pellicer C, Agullés MJ (H. Francesc de Borja, Gandía); Romero PJ (Fac. de Medicina, Granada); Sebastián AF, Anoro L, Alfonso JI (H. Clínico U. “Lozano Blesa”, Zaragoza); Plaza V, Garriga T, Gras JR (H. Sant Pau, Barcelona). Latin America: Carrasco I, Cukier G, Meléndez A, Hernández V (H. Santo Tomás, Panamá, Panamá); Neffen H, Busaniche G (H. de Niños “O. Allassia”, Santa Fe, Argentina); Rodrigo G, Charlone R, Percovich M (H. Central de las Fuerzas Armadas, Montevideo, Uruguay); Tálamo C, Ruiz A (H. Clínico Universitario, Caracas, Venezuela). RESULTS Frequency of sinus disease phenotypes in asthmatic patients. No sinonasal disease. Non-Allergic Rhinitis (NAR). Allergic Rhinitis (AR). Rhinosinusitis without Nasal Polyps (CRSsPN). Rhinosinusitis with Nasal Polyps (CRSwPN). CONCLUSIONS REFERENCES MATERIALS & METHODS Study population. Asthmatic patients (N=492; mean age 45±15 yo; female 70.5%) were recruited according to GINA: 17.3% intermittent and 82.7% persistent [24.6% mild, 31.4% moderate, 26.7% severe] in a prospective study carried out in 2010-2011 by pneumonologists and ENT specialists in 23 centers from Spain and Latinoamerica. Clinical outcomes. Allergic (AR) and non- allergic (NAR) rhinitis and CRS with (CRSwNP) and without (CRSsNP) nasal polyps were evaluated according to ARIA and EPOS guideline definitions based on nasal symptoms, skin prick test (SPT), nasal endoscopy, and sinus CT scan. Statistical analysis. A descriptive analysis was performed of all cases for all variables collected. Values ​​ are expressed as mean and standard deviation (SD) or as a percentage. The means of quantitative variables were compared between groups by nonparametric analysis (Mann- Whitney) and the qualitative variables by chi-square test. The association of quantitative variables was studied with the Pearson correlation coefficient (r). In all contrasts the null hypothesis was rejected at p = 0.05. The statistical package used was SPSS version 15.0 (SPSS for Windows, Chicago, USA). 1) Most asthmatic patients (86%) have nasal symptoms, 50% of them having rhinitis alone and 36% chronic rhinosinusitis. 2)The “loss of smell” may be considered the symptom-guide to discriminate CRS (mainly with nasal polyps) from rhinitis alone in asthma patients. 1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens J, Togías A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy 2008:63(Suppl 86):8-160. 2. Global Strategy for Asthma Management and Prevention NHLBI/WHO Workshop Report. 2006. http://www.ginasthma.com.http://www.ginasthma.com 3 Plaza V, A lvarez FJ, Casan P, Cobos N, Lo pez Viña A, Llauger MA, et al. Guía Española para el Manejo del Asma. Arch Bronconeumol 2004;40:72-79. www.gemasma.com www.gemasma.com 4 Castillo JA, Molina J, Valero A, Mullol J. Prevalence and characteristics of rhinitis in asthmatic patients attended in Primary Care in Spain (RINOASMAIR Study). Rhinology 2010;48:35-40. 5 Valero A, Ferrer M, Sastre J, Navarro AM, Monclus L, Martí-Guadaño E, Herdman M, Dávila I, Del Cuvillo A, Colás C, Baró E, Antépara I, Alonso J, Mullol J. A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items. J Allergy Clin Immunol 2007;120(2):359-65. 6. Fokkens WJ, Lund V, Mullol J, C Bachert, I Alobid, F Barrody, N Cohen, A Cervin, R Douglas, P Gevaert, C Gorgalas, H Goossens, R Harvey, P Hellings, C Hopkins, N Jones, G Goos, L Kalogjera, B Kern, M Kowalski, D Price, H Riechelmann, R Schlosser, B Senior, M Thomas, E Toskala, R Voegels, D-Y Wang, PJ Wormald. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. Rhinology 2012;50(Suppl 23):1- 298. Loss of smell as symptom-guide to discriminate chronic rhinosinusitis from rhinitis alone in asthma patients Table 2. Demographic characteristics of asthma patients. CharacteristicsMean (SD) N (%)Range Age, years (x±SD)45 ± 1518 - 71 BMI, kg/m 2 (x±SD)26.9 ± 5.216.8 - 49.8 Women, N (%)347 (70.5) - Smokers, N (%)47 (9.6) - Table 3.Incidence (%) of sinonasal symptoms in asthmatic patients Sneezing Nasal itching Ocular itching Anterior rhinorrea Posterior rhinorrea Nasal congestion Loss of smell Facial pain pressure R 86.676.668.678.2 - 82.843.6 - NAR (%) 77.464.554.869.4 - 75.841.7 - AR (%) 89.880.873.481.4 - 85.344.4 - CRS 87.1 - 73.683.179.888.876.4 *** 57.9 CRSwNP (%) 81.3 - 66.780.279.283.383.3†59.4 CRSsNP (%) 93.9 - 81.786.672.095.168.356.1 Incidence (%) of sinonasal symptoms in asthmatic patients with rhinitis (AR or NAR) or chronic rhinosinusitis (CRSwNP or CRSsNP) based on ARIA and EPOS. Loss of smell significantly discriminated between CRS and rhinitis (76.4% vs 41.0%, p<0.001) ***, p<0.001 CRS vs rhinitis; †, p<0.05 CRSwNP vs CRSsNP 49.6 % 36.2 % Asthmatic patients No rhinitis / No CRS Non Allergic Rhinitis (NAR) Allergic Rhinitis (AR) CRS without nasal polyps CRS with nasal polyps No sinonasal disease Rhinitis PRICK - Rhinitis PRICK + CRS NP - CRS NP + Table 1. Asthma study population by GINA severity. Asthma severity Number of cases: 492 % Intermittent asthma8517.3% Mild persistent asthma12224.6% Moderate persistent asthma15431.4% Severe persistent asthma 131 26.7% Conflict of interest: This study was designed and conducted by the Rhinitis Group of the SEPAR Asthma Area, and funded in part by MSD Spain and by the Integral Research Program (PII) of SEPAR CLINICALTRIALS.GOV ID : NCT01513837