Certain subgroups of patients with overlapping asthma and chronic rhinosinusitis should undergo high-resolution computed tomography (HRCT) to ensure earlier diagnosis and treatment of bronchiectasis, according to the results of a prospective study published in BMC Pulmonary Medicine. Subgroups benefitting from HRCT include those with nasal polyps, more severely impaired lung function, higher circulating levels of eosinophils, and more frequent acute asthma attacks.

In this study, researchers at a hospital in Beijing, China, assessed the prevalence, inflammatory characteristics, and clinical implications of bronchiectasis in a cohort of 176 consecutive patients with overlapping asthma and chronic rhinosinusitis.

Within the study cohort, 72 (40.91%) individuals were diagnosed with bronchiectasis. These patients had a higher incidence of nasal polyps (P=.004), higher Lund-Mackay scores (P=.044), higher proportion of 1 or more severe exacerbations of asthma in the past 12 months (P=.003), lower postbronchodilator forced expiratory volume in 1 second (FEV1%) predicted (P=.006), and elevated peripheral blood eosinophil counts (P=.022).


Continue Reading

The researchers developed a model to predict bronchiectasis in patients with asthma and chronic rhinosinusitis using cutoff values of FEV1% predicted less than or equal to 71.40%, peripheral blood eosinophil counts greater than 0.60× 109/L, presence of nasal polyps, and at least 1 severe exacerbation of asthma in the last 12 months.

The investigators concluded, “The coexistence of radiographic bronchiectasis in [patients with asthma and chronic rhinosinusitis] is common and predicts a distinct disease subset with more severe eosinophilic airway inflammation, more serious asthma and {chronic rhinosinusitis], and lower quality of life.” They added, “We suggest that [patients with asthma and chronic rhinosinusitis and nasal polyps], severe airflow obstruction, eosinophilic inflammation, and poor asthma control should receive HRCT for the early diagnosis of bronchiectasis.”

Reference

Sheng H, Yao X, Wang X, Wang Y, Liu X, Zhang L. Prevalence and clinical implications of bronchiectasis in patients with overlapping asthma and chronic rhinosinusitis: a single-center prospective study. BMC Pulm Med. 2021;21(1):211. doi: 10.1186/s12890-021-01575-7