A recent study from Norway has said that patients who have COPD together with rhinosinusitis without nasal polyps (RSsNP) have an inferior disease-specific and general health-related quality of life (HRQoL).(1)

The observational cross-sectional study enrolled 90 patients with COPD and 93 subjects as control aged 40-80 years. Those individuals who had previous sinonasal surgery, any systemic disease with a nasal manifestation, nasal tumour, asthma, symptoms of common cold within the previous two weeks, presence of nasal polyps on endoscopy, exacerbation of COPD within the last 6 weeks and use of long-term oxygen therapy were not included in the trial.

The general and disease-specific HRQoL were compared between COPD patients and controls as well as the subgroups of COPD patients with and without RSsNP. The general HRQoL was assessed with the Short Form-36 (SF-36v2) questionnaire, while the disease-specific HRQoL was assessed by Sinonasal outcome test-22 (SNOT-22), St. Georges Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT).

Around 56.5% of patients who had COPD and also RSsNP were found to have severe and very severe airflow obstruction in comparison to 38.6% of patients without RSsNP. Patients who had COPD with RSsNP scored higher on SNOT-22 and psychological subscale tests versus those without RSsNP. The mean scores among the two groups were 36.8 and 22.6 vs 9.5 and 6.5, respectively.

Patients who had COPD with RSsNP also had significantly higher total scores (mean) on SGRQ compared to COPD patients who did not have RSsNP; 43.3 vs 34, respectively. The total CAT score was significantly higher in patients who had COPD with RSsNP than those who had COPD without RSsNP; 18.8 vs13.5 respectively. COPD patients with RSsNP had four-fold greater chances of having CAT scores suggestive of high or very high impact on their HRQoL. According to the authors, this can be construed as “patients stop doing most of what they want to do, exercise is not safe and everything seems too much of an effort, and no good days in the week”. However, no association with sleep quality was noted in the study.

These results, published in the journal Respiratory Medicine show that the overall COPD-related HRQoL was poorer in COPD patients with RSsNP because of the greater symptom burden and psychological problems such as feeling sad or embarassed, irritable, fatigue and decreased concentration and productivity, which further restricted their physical activity.

Intranasal steroids are helpful in patients with RSsNP; this may reduce disease-specific symptoms and also alleviate psychological problems that patients with COPD may be experiencing thereby improving their quality of life.

The concept of “one airway – one disease”, which recognizes allergic rhinitis and asthma as manifestations of the same airway disease, also may be pertinent for patients with COPD and chronic rhinosinusitis. Based on their findings, the study authors suggest that RSsNP “should be recognized as a comorbidity of COPD”. All COPD patients therefore must also be screened for RSsNP.

Reference

1. Øie MR, et al. Rhinosinusitis without nasal polyps is associated with poorer health-related quality of life in COPD. Respir Med. 2021 Oct 14;189:106661.