Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review
Abstract Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) have been increasingly recognized as an important clinical issue. The purpose of this study is to summarize the current definitions and evaluation parameters of AE and then identify and quantify the clinical and immunopatho...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2020-08-01
|
| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40463-020-00459-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850283120602906624 |
|---|---|
| author | Dawei Wu Benjamin Bleier Yongxiang Wei |
| author_facet | Dawei Wu Benjamin Bleier Yongxiang Wei |
| author_sort | Dawei Wu |
| collection | DOAJ |
| description | Abstract Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) have been increasingly recognized as an important clinical issue. The purpose of this study is to summarize the current definitions and evaluation parameters of AE and then identify and quantify the clinical and immunopathologic characteristics of AE in CRS. Methods A systematic review of the literature was performed on PubMed, Scopus, and Cochrane databases from January 1990 through August 2020 to identify studies relating to AE in CRS. Exclusion criteria included non-English and non-human studies, and case reports. Results The definitions of AE in CRS among all the studies were based on a description of short-term worsening sinonasal symptoms. Patient-reported sinus infection and exacerbation related medical treatment during the preceding 3 months to 1 year were used to evaluate the frequency of AE in CRS. The average decline in 22-item Sino-Nasal Outcome Test (SNOT-22) score during an exacerbation was 7.83 points relative to baseline. Comorbid asthma, SNOT-22 scores ≥24, allergic rhinitis, eosinophil count ≥150/μL and autoimmune disease were positively associated with an exacerbation-prone CRS phenotype. AE in chronic rhinosinusitis with nasal polyps (CRSwNP) was associated with increased expression of mucus cytokines including myeloperoxidase (percentage increase [PI] = 101%), IL-5 (PI = 125%), and IL-6 (PI = 162%) and could be predicted by the increasing mucus cystatin and periostin. Conclusion The definition of AE in CRS is largely driven by patient-reported symptoms and is associated with several risk factors. Quantitative changes in mucus cytokines associated with AE in CRSwNP and may be used to predict events. The development of a consistent definition of AE in CRS is critical to help define disease control and treatment efficacy. |
| format | Article |
| id | doaj-art-8ae33924eca24f1abc4ad47316c873ac |
| institution | OA Journals |
| issn | 1916-0216 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-8ae33924eca24f1abc4ad47316c873ac2025-08-20T01:47:50ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162020-08-014911910.1186/s40463-020-00459-wDefinition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic reviewDawei Wu0Benjamin Bleier1Yongxiang Wei2Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical UniversityDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical SchoolDepartment of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical UniversityAbstract Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) have been increasingly recognized as an important clinical issue. The purpose of this study is to summarize the current definitions and evaluation parameters of AE and then identify and quantify the clinical and immunopathologic characteristics of AE in CRS. Methods A systematic review of the literature was performed on PubMed, Scopus, and Cochrane databases from January 1990 through August 2020 to identify studies relating to AE in CRS. Exclusion criteria included non-English and non-human studies, and case reports. Results The definitions of AE in CRS among all the studies were based on a description of short-term worsening sinonasal symptoms. Patient-reported sinus infection and exacerbation related medical treatment during the preceding 3 months to 1 year were used to evaluate the frequency of AE in CRS. The average decline in 22-item Sino-Nasal Outcome Test (SNOT-22) score during an exacerbation was 7.83 points relative to baseline. Comorbid asthma, SNOT-22 scores ≥24, allergic rhinitis, eosinophil count ≥150/μL and autoimmune disease were positively associated with an exacerbation-prone CRS phenotype. AE in chronic rhinosinusitis with nasal polyps (CRSwNP) was associated with increased expression of mucus cytokines including myeloperoxidase (percentage increase [PI] = 101%), IL-5 (PI = 125%), and IL-6 (PI = 162%) and could be predicted by the increasing mucus cystatin and periostin. Conclusion The definition of AE in CRS is largely driven by patient-reported symptoms and is associated with several risk factors. Quantitative changes in mucus cytokines associated with AE in CRSwNP and may be used to predict events. The development of a consistent definition of AE in CRS is critical to help define disease control and treatment efficacy.http://link.springer.com/article/10.1186/s40463-020-00459-wChronic rhinosinusitisNasal polypsAcute exacerbationDefinitionClinical characteristicsImmunologic characteristics |
| spellingShingle | Dawei Wu Benjamin Bleier Yongxiang Wei Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review Journal of Otolaryngology - Head and Neck Surgery Chronic rhinosinusitis Nasal polyps Acute exacerbation Definition Clinical characteristics Immunologic characteristics |
| title | Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review |
| title_full | Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review |
| title_fullStr | Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review |
| title_full_unstemmed | Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review |
| title_short | Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review |
| title_sort | definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis a systematic review |
| topic | Chronic rhinosinusitis Nasal polyps Acute exacerbation Definition Clinical characteristics Immunologic characteristics |
| url | http://link.springer.com/article/10.1186/s40463-020-00459-w |
| work_keys_str_mv | AT daweiwu definitionandcharacteristicsofacuteexacerbationinadultpatientswithchronicrhinosinusitisasystematicreview AT benjaminbleier definitionandcharacteristicsofacuteexacerbationinadultpatientswithchronicrhinosinusitisasystematicreview AT yongxiangwei definitionandcharacteristicsofacuteexacerbationinadultpatientswithchronicrhinosinusitisasystematicreview |