Background: The prevalence and nature of upper respiratory changes in patients with COPD and its impact on COPD outcomes are unclear.
Methods: Patients with stable COPD GOLD stages 1-4 and a control group without COPD matched in gender and age were recruited at the University Hospital Basel. The difference in the Sino-Nasal-Outcome-20 questionnaire (SNOT-20) score was compared between the COPD cohort and the control group. Secondary outcomes were sub-scores SNOT-Primary Nasal Symptoms (SNOT-PNS), SNOT-Secondary Nasal Symptoms (SNOT-SNS) and SNOT-Quality of Life (SNOT-QOL). Abnormal findings were defined as a value of >12 points and absolute values were compared.
Furthermore the Rhino-conjunctivitis Quality of Life questionnaire (RQLQ) and three visual analogue scales (VAS) estimating the amount of nasal secretions, bilateral perception of nasal congestion and nasal itching, were applied. As objective clinical surrogate markers for nasal inflammation, computer tomography (CT) scans of the para-nasal sinuses were performed and assessed with the Newman and the Lund-Mackay scoring system.
Results: Data from 83 COPD patients (35 females, mean age: 67 years ± 10) and 34 controls (18 females, mean age: 67 years ± 12) were analysed. Forty-eight COPD patients (59%) and 14 controls (41%) had an abnormal SNOT-20 score
(p=0.088). An abnormal SNOT-PNS score was found in 49 COPD patients (59%) and in 9 controls (26%) (p<0.01). SNOT-PNS, SNOT-SNS, RQLQ and nasal symptoms (VAS) showed significantly higher values in the COPD group compared to the control group (all p<0.01). Forty-eight COPD patients (59%) and 12 control patients (35%) had an abnormal Lund-Mackay score (p=0.02). The COPD group had a significantly higher median CT Lund-Mackay (p=0.03).
Also, forty-eight COPD patients (58%) showed a pathological CT Newman score, whereas 12 controls (35%) had an abnormal CT Newman score (p=0.03). The COPD group had a significantly higher median CT Newman score with 2.0 (ICR 4) than the control group with 0.0 (ICR 1) (p=0.03). Nasal symptom and CT scores did not correlate with each other.
Conclusion: Evidence for a higher prevalence of subjective and radiographic signs of rhino-sinusitis in COPD patients compared to controls without COPD was found. Current smoking was highly associated with findings in SNOT-PNS scores (p<0.01) and abnormal CT Newman scores (p=0.046), but did not show significantly more abnormal SNOT-20 scores (p=0.11).
Table of Content
Summary
Background
Outline of the Chronic Obstructive Pulmonary Disease (COPD)
Definition
Burden of COPD
Influencing Factors on Disease Development and Progression
Vicious Circle Hypothesis in the Pathogenesis and Pathophysiology of COPD
Diagnosis and Classification
COPD GOLD Staging
Combined COPD Risk Assessment
Research Questions of the Present Dissertation
Outline of Chronic Rhino-Sinusitis (CRS)
Definition
Burden of CRS
Epidemiology of CRS
Epidemiology of CRS in COPD Patients
The Role of Allergy in Rhino-Sinusitis
Assessment of Severity of CRS
Examination Tools for CRS Assessment
Validation of subjective Symptom Assessment
Background of the “United Airway Disease”
Differences and similarities between Nasal and Bronchial Mucosa
Background of the Impact of cigarette smoking on upper airway involvement
Background regarding the Influence of upper airway involvement on COPD severity
Materials and Methods
Subjects
Ethical Consideration, Data Protection, and Patient Information
Study design
Data Analysis
Examination Tools
Clinical Interview
Spirometry
SNOT-20-GAV
Visual Analogue Scales (VAS)
Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ)
Exhaled bronchial and nasal nitric oxide
Skin Prick Test
CT Scan
Power analysis
Statistical analysis
Results
Study Flow Charts
Demographical Characteristics and Clinical Features of the Patients
Patients’ reports of upper airway symptoms were more frequent in the COPD cohort but they were not associated with a poorer quality of life
SNOT-20-GAV
Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ)
Visual Analogue Scales (VAS)
Pathological radiographic findings were more frequent in the COPD cohort while there was no difference in Nitric Oxide markers
Newman Staging System
Lund-MacKay Staging System
Correlation between Subjective and Objective Parameters of upper airway involvement
Impact of cigarette smoking on upper airway involvement
Influence of upper airway involvement on COPD severity
Discussion
Subjective reports of the upper airway symptoms were more frequent in the COPD cohort but they were not associated with a worse quality of life
Radiographic pathologic findings were more frequent in the COPD cohort
Correlation between Subjective and Objective Parameters for upper airway involvement
Impact of cigarette smoking on upper airway involvement and Quality of Life
Limitations
Conclusion
Research Objectives and Topics
This dissertation investigates the prevalence and clinical significance of upper respiratory tract symptoms and chronic rhino-sinusitis (CRS) in patients with Chronic Obstructive Pulmonary Disease (COPD) compared to a control group, while analyzing the correlation between subjective patient reports and objective clinical findings.
- Prevalence of sino-nasal symptoms in COPD patients versus controls
- Objective radiographic assessment of sinus pathology using Newman and Lund-MacKay scoring systems
- Impact of upper airway involvement on COPD disease severity and patient quality of life
- Role of cigarette smoking as a confounding factor in upper airway disease
- Correlation analysis between patient-reported outcomes (SNOT-20) and objective clinical diagnostic tools
Excerpt from the Book
Vicious Circle Hypothesis in the Pathogenesis and Pathophysiology of COPD
A variety of factors contribute to lung inflammation. It is hypothesized that those factors are triggers and COPD develops in the manner of a vicious circle. Figure 3 demonstrates the assumed cause-and-effect relationships.
Long-term exposure to triggers can lead to enhanced mucus secretion, disruption of normal ciliary activity, and airway epithelial injury. This results in impaired mucociliary clearance, which allows bacteria to colonize the lower airways. (15) The bacterial products are in a constant turnover with the airway epithelium and lead to further airway epithelial injury and an inflammatory response. The processes following this inflammation as a consequence lead to the development and progression of COPD.
Summary of Chapters
Background: Provides an overview of COPD definitions, epidemiology, and the pathophysiology of the disease, including the vicious circle hypothesis.
Research Questions of the Present Dissertation: Outlines the primary aim to investigate upper respiratory symptoms and CRS in COPD patients versus a healthy control group.
Outline of Chronic Rhino-Sinusitis (CRS): Defines CRS diagnostic criteria and discusses the burden of disease, including epidemiological data and assessment tools.
Background of the “United Airway Disease”: Examines the physiological and anatomical connections between the upper and lower respiratory tracts.
Background of the Impact of cigarette smoking on upper airway involvement: Reviews literature on how smoking influences nasal mucosa and symptom prevalence.
Background regarding the Influence of upper airway involvement on COPD severity: Discusses how upper airway disease might influence quality of life and clinical COPD outcomes.
Materials and Methods: Details the case-control study design, patient recruitment criteria, and the specific examination tools like SNOT-20, CT scans, and spirometry used.
Results: Presents the findings regarding symptom frequency, radiographic outcomes, and correlations between subjective reports and objective clinical scores.
Discussion: Interprets the study results in the context of existing literature, addresses the study's limitations, and discusses the lack of correlation between symptom severity and COPD outcomes.
Conclusion: Summarizes that while subjective and objective signs of rhino-sinusitis are more prevalent in COPD patients, their clinical impact on COPD severity remains unclear.
Keywords
COPD, Chronic Obstructive Pulmonary Disease, Rhino-sinusitis, CRS, SNOT-20, Computed Tomography, Lund-MacKay score, Newman score, airway inflammation, spirometry, United Airway Disease, cigarette smoking, patient-reported outcomes, upper respiratory tract, case-control study
Frequently Asked Questions
What is the core focus of this research?
This work explores the link between COPD and chronic rhino-sinusitis, specifically assessing how often these patients experience upper respiratory symptoms and whether these symptoms correlate with objective signs of sinus inflammation.
What are the primary themes covered in the study?
Key themes include the comparison of symptom prevalence between COPD and non-COPD groups, the validation of subjective symptom questionnaires against objective CT scan data, and the potential impact of smoking on the upper airways.
What is the primary goal of this dissertation?
The main objective is to investigate the clinical relationship between COPD and upper respiratory pathologies, evaluating their prevalence and their impact on quality of life and overall disease outcomes.
Which scientific methods were employed?
The study utilized a case-control design, employing clinical interviews, spirometry, patient-reported outcome measures (SNOT-20, RQLQ), Visual Analogue Scales (VAS), and objective diagnostic imaging (CT scans evaluated via Newman and Lund-MacKay scoring).
What does the main part of the work address?
It provides a comprehensive review of COPD and CRS pathophysiology, describes the study methodology in detail, and presents the clinical results regarding the frequency of nasal symptoms and radiographic pathological findings in the studied cohorts.
Which keywords define this work best?
COPD, Rhino-sinusitis, SNOT-20, CT imaging, airway inflammation, and patient-reported outcomes are the most significant descriptors.
How did the researchers define a 'positive' finding for sinusitis in CT scans?
A score greater than zero in either the Lund-MacKay or Newman staging systems was classified as abnormal or pathological.
Did the study find that upper airway symptoms significantly affect COPD exacerbation rates?
No, the study concluded that while upper airway symptoms and radiographic signs of rhino-sinusitis are more frequent in COPD patients, they did not show a statistically significant correlation with COPD exacerbation frequency or disease severity stages.
What role does cigarette smoking play according to this study?
The study found that current smoking is strongly associated with abnormal findings in the upper respiratory tract, such as higher SNOT-PNS scores and pathological CT scans, though its specific contribution to overall COPD severity remains complex.
- Quote paper
- Dr. med. Claudia Gerhards (Author), 2015, Rhino-Sinusitis is a frequent problem in COPD, Munich, GRIN Verlag, https://www.grin.com/document/310996
