Chronic rhinosinusitis severity is associated with need for asthma-related systemic corticosteroids

Background: Chronic rhinosinusitis (CRS) is highly prevalent in patients with asthma.However, no study has evaluated the effect of CRS severity on asthma-related oral corticosteroid use -a marker of poor asthma control and prognosis.We therefore sought to evaluate the association between CRS severity and asthma-related oral corticosteroid use. Methodology:Prospective cross-sectional study of 110 adult asthmatic CRS patients.CRS severity was measured using the 22item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy score.Number of asthma-related courses of oral corticosteroids in the past year was queried at enrollment.Association was sought between metrics for CRS severity and asthma-related oral corticosteroids use in the last year.Receiver operating characteristic (ROC) curves defined whether SNOT-22 or endoscopy scores could be used for detecting asthma-related oral corticosteroid use. Results:The mean SNOT-22 score was 44.9 (standard deviation [SD] : 23.3) and mean endoscopy score was 4.1 (SD: 3.0).The mean number of asthma-related oral corticosteroid courses taken in the last year was 1.1 (SD: 1.9).SNOT-22, but not endoscopy score, was associated with requiring at least one course of asthma-related oral corticosteroids in the last year (odds ratio = 1.03, 95%CI:1.02 -1.06, p=0.003), which translates to an odds ratio of 2.0 for a 21-point increase in SNOT-22.ROC analysis identified equally optimal SNOT-22 scores of greater than 32 (sensitivity: 88.1%, specificity: 41.2%) or greater than 65 (sensitivity: 38.1%, specificity: 91.2%) for detecting the need for at least one course of oral corticosteroids within the past year.Conclusions: CRS symptom severity is associated with past asthma-related oral corticosteroid use.SNOT-22 scores may be used as a versatile tool to screen for past asthma-related oral corticosteroid use in asthmatic CRS patients -i.e.those at greatest risk from their asthma -with either high sensitivity or high specificity.