Comorbidities appear prevalent among patients with rhinitis, rhinosinusitis
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Key takeaways:
- The most common comorbidities among patients with rhinitis and rhinosinusitis included asthma, other chronic respiratory diseases, musculoskeletal diseases and cardiovascular diseases.
- 3.9% of all patients had nonsteroidal anti-inflammatory drug-exacerbated respiratory disease.
- A patient’s visit burden increased with more inflammatory upper airway diseases.
Patients with rhinitis and rhinosinusitis frequently suffered from comorbidities that imposed a significant burden on outpatient care, according to a study published in Clinical and Translational Allergy.
However, active management of these diseases could have a positive socioeconomic impact, Annina Lyly, MD, MPhil, PhD, researcher with the Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, and colleagues wrote in the study.
The researchers evaluated the relative proportion of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) and other comorbidities as well as their effect on outpatient visits due to allergic rhinitis (AR), nonallergic rhinitis (NAR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) with (CRSwNP) or without (CRSsNP) nasal polyps,.
“There is little knowledge of the relative proportion of NERD and other comorbidities and their impact on the burden of outpatient visits due to AR/NAR/ARS/CRS,” Lyly told Healio.
The retrospective, registry-based follow-up study analyzed a random sample of 5,080 patients (mean age, 33.6 ± 20.7 years; 56.1% female) diagnosed with AR (33.5%), NAR (27.5%), ARS (27.2%), CRSsNP (20.7%) or CRSwNP (10.9%) registered at outpatient visits treated in the Hospital District of Helsinki and Uusimaa in Finland between 2015 and 2019.
Mean follow-up times were 8.6 years for adults, 8 years for patients aged 18 years and younger and 8.5 ± 3.4 years overall.
Patients with AR represented the youngest group, aged 20.2 ± 17.5 years, and had the fewest visits during the follow-up period (2.8 ± 6.2). Patients with CRSwNP, who were 60.5% male, were the oldest group, aged 47 ± 15.9 years, and had the most visits (10.2 ± 14.3). The other diagnosis groups were predominantly female.
“Almost all comorbidities were associated with a high frequency of rhinologic outpatient visits,” Lyly said.
There was a high overlap between upper airway diagnoses in rhinitis and rhinosinusitis patients, the researchers found, with at least one other comorbidity appearing with rhinitis or rhinosinusitis in 89.6% of patients.
Most frequently, these comorbidities included asthma (44.4%), other chronic respiratory diseases (38.5%), musculoskeletal diseases (38.4%) and cardiovascular diseases (35.7%).
Researchers calculated relative proportions of 44.4% for comorbid asthma, ranging from 73.7% of AR cases to 27.6% of ARS cases; 51% for comorbid allergy, ranging from 100% of AR cases to 22.5% of ARS cases; and 3.9% for comorbid NERD, ranging from 17.7% of CRSwNP cases to 2.3% of AR cases.
Patients with NAR and AR more frequently had comorbid chronic respiratory diseases other than asthma compared with patients with CRS. Also, patients with CRSwNP had high relative proportions of cardiovascular diseases (41.3%), diabetes (14.3%) and obstructive sleep apnea (13.7%). Specifically, patients with CRSwNP and acute exacerbations had the highest relative proportions of asthma (70.8%), allergy (59.7%), musculoskeletal diseases (54.2%), cardiovascular diseases (47.2%), NERD (22.2%), cancer (18.1%), diabetes (16.7%), gastroesophageal reflux disease (9.7%), immunodeficiency or its suspicion (9.2%), mouth breathing (6.94%) and memory diseases (6.9%).
Comorbidities across all cases also included musculoskeletal diseases (38.4%), mental disorders (18.9%), cancer (10.1%), obesity (10%), chronic otitis media (6.2%) and tonsillar disease (6.4%).
Patients had a mean visit count for the entire follow-up period of 5.1 ± 8.8, with an average of 227 ± 321 days between visits. Patients with CRSwNP had the highest number of visits during the follow-up period at 10.2 ± 14.3 and the shortest interval between visits at 196.6 ± 217.6 days.
Overall, 18% of all patients had one other disease, 17.6% had two, 17% had three and 37% had four or more.
Noting the strong overlap between upper respiratory diseases, the researchers found that other chronic respiratory diseases were the most frequent comorbidities, although musculoskeletal and cardiovascular diseases were common as well.
About a fifth of these patients had coexisting AR, NAR, ARS or CRS diagnoses, and more than a third of the rhinitis and rhinosinusitis patients had asthma and other chronic respiratory, musculoskeletal and/or cardiovascular diseases.
“Their presence seems to increase visit frequency, possibly reflecting increased direct and indirect costs and suffering,” Lyly said.
As the number of inflammatory upper airway diseases increases the risk for visit burden among these patients, the researchers wrote, providers could use these findings in patient counseling and planning treatment, with socioeconomic benefits.
“Comorbidities need to be taken care of properly, as this might reduce suffering and costs. Patients need to be informed that if they have comorbidities, this might affect the morbidity of rhinologic diseases as well,” Lyly said. “We will continue analyses in a bigger hospital patient sample.”
For more information:
Annina Lyly, MD, MPhil, PhD, can be reached at annina.lyly@helsinki.fi.