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Tuli JF, Ramezanpour M, Cooksley C, Bouras GS, Ogi K, Feizi S, Nepal R, Psaltis AJ, Wormald P, Vreugde S. Increased antibiotic resistance of Pseudomonas aeruginosa isolates from chronic rhinosinusitis patients grown in anaerobic conditions. Laryngoscope Investig Otolaryngol 2024; 9:e1244. [PMID: 38736943 PMCID: PMC11081418 DOI: 10.1002/lio2.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction In chronic rhinosinusitis (CRS), the congestion and blockage of the nose can cause anaerobic conditions within the sinus cavities which may promote the expression of virulence and antibiotic resistance genes in invading pathogens. Pseudomonas aeruginosa is a facultative anaerobic bacteria and causes severe recalcitrant CRS. In this study, we aimed to evaluate the antimicrobial resistance of P. aeruginosa isolates of CRS patients in planktonic and biofilm form grown in aerobic and anaerobic conditions. Methods P. aeruginosa clinical isolates of CRS patients (n = 25) were grown in planktonic and biofilm form in aerobic and anaerobic conditions. Minimum inhibitory concentrations (MIC) of planktonic forms and minimum biofilm eradication concentrations (MBEC) were determined. Additionally, metabolic activity by fluorescein diacetate assay, biofilm biomass by crystal violet assay and eDNA concentration were assessed in both conditions. Results P. aeruginosa planktonic cells grown in anaerobic condition exhibited increased gentamicin resistance (p < .01), whereas P. aeruginosa biofilms grown in anaerobic condition displayed significantly increased MBEC values for gentamicin (p < .0001) and levofloxacin (p < .001). The metabolic activity of anaerobic biofilms was significantly higher compared with aerobic biofilms (p < .0001). However, the biofilm biomass of isolates grown in aerobic conditions was higher than anaerobic conditions (p < .5). Conclusion P. aeruginosa isolates from CRS patients grown in anaerobic conditions showed significantly increased resistance to antibiotics with an increased metabolic activity but decreased biofilm biomass. Level of Evidence NA.
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Affiliation(s)
- Jannatul Ferdoush Tuli
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Mahnaz Ramezanpour
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Clare Cooksley
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - George Spyro Bouras
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Kazuhiro Ogi
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Sholeh Feizi
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Roshan Nepal
- CSIRO Marine and Atmospheric ResearchThe Commonwealth Scientific and Industrial Research Organisation (CSORO)HobartTasmaniaAustralia
| | - Alkis James Psaltis
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Peter‐John Wormald
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Sarah Vreugde
- Department of Surgery–Otolaryngology, Head and Neck SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
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2
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Beswick DM, Liu CM, Overdevest JB, Zemke A, Khatiwada A, Gudis DA, Miller JE, Kimple A, Tervo JP, DiMango E, Goralski JL, Keating C, Senior B, Stapleton AL, Eshaghian PH, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Getz AE, Hwang PH, Khanwalker A, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner GA, Wang MB, Saavedra MT, Taylor Cousar JL. Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis. Laryngoscope 2024. [PMID: 38634358 DOI: 10.1002/lary.31438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The 22-question SinoNasal Outcome Test (SNOT-22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT-22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT-22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF). METHODS Prospective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMT's impact on CRS. For participants enrolled prior to HEMT initiation, SNOT-22 scores were obtained at baseline and after 3-6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbach's alpha and four distribution-based methods were used to assess internal consistency and calculate the MCID of the SNOT-22. RESULTS A total of 184 PwCF participated with mean baseline SNOT-22 scores ranging from 18.1 to 56.7. Cronbach's alpha was ≥0.90 across sites. Participants at sites with pre- and post-HEMT data reported improvement in SNOT-22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT-22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02-1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14-18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39-20.11) were associated with greater SNOT-22 improvement. The mean MCID calculated via distribution-based methods was 8.5. CONCLUSION Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF is 8.5 points, similar to non-CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT-22 has strong internal consistency in PwCF. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Christine M Liu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Anna Zemke
- Division of Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, U.S.A
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Adam Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jeremy P Tervo
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Emily DiMango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Jennifer L Goralski
- Department of Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Claire Keating
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, U.S.A
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, U.S.A
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Ashoke Khanwalker
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Greenville, South Carolina, U.S.A
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Grant A Turner
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Jennifer L Taylor Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
- Department of Pediatrics, National Jewish Health, Denver, Colorado, U.S.A
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Uyttebroek S, Dupont L, Jorissen M, Van Gerven L. Upper Airway Disease in Adults with Cystic Fibrosis in the Era of CFTR Modulators. Laryngoscope 2023; 133:2898-2909. [PMID: 36912358 DOI: 10.1002/lary.30642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is prevalent in people with cystic fibrosis (PwCF) and is often refractory to treatments. Uncontrolled CRS might negatively impact the lower airways and the quality of life. The aim of this study is to evaluate the burden of cystic fibrosis (CF)-related CRS in the era of CF transmembrane conductance regulator (CFTR) modulators. METHODS Adult PwCF were asked to fill in a questionnaire on sinonasal complaints, they underwent a nasal endoscopy, bacteriological sampling, and a CT scan. Afterwards, these outcome measures were compared between patients treated with and without modulators. RESULTS In the 122 included patients, CRS was present in 83%. CFTR modulators were prescribed in 48% of the patients, with a median of 10 months since the start of the treatment. Subjectively, the median SNOT-22 score was 16/110. Objectively, a median Lund-Kennedy score of 6/12 and modified Lund-Mackay score of 10/24 were observed. No correlation could be found between SNOT-22 score and other outcome measures including endoscopy and radiology. Altogether, 21% of the patients had controlled disease. When comparing patients treated with and without modulators, significantly lower CT scores (p = 0.0018) and less bacterial colonization (p = 0.0082) were observed in patients receiving modulators. CONCLUSION CF-CRS is highly prevalent in our cohort and only the minority of PwCF has a well-controlled disease. A multidisciplinary ENT-pneumology clinic would be beneficial, as there is a high discrepancy between patient-reported symptoms and the extent of the disease. CFTR modulators are promising, as lower CT scores and less bacterial colonization were observed in the modulator group. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:2898-2909, 2023.
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Affiliation(s)
- Saartje Uyttebroek
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Pneumology, UZ Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head and Neck surgery, UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolarygology, Rhinology Research, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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Rezende GL, Nakanishi M, Couto SCP, Martins CLFS, Sampaio ALL, Albuquerque LFF, Kückelhaus SAS, Muniz-Junqueira MI. Alterations in innate immune responses of patients with chronic rhinosinusitis related to cystic fibrosis. PLoS One 2022; 17:e0267986. [PMID: 35522627 PMCID: PMC9075614 DOI: 10.1371/journal.pone.0267986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
The role of phagocytes of children with cystic fibrosis (CF) associated with different phenotypes of chronic rhinosinusitis (CRS) is unclear. The aim of this study was to evaluate the phagocytic capacity of blood neutrophils and monocytes and production of superoxide anion by phagocytes in patients with CF with or without chronic rhinosinusitis and with or without nasal polyps (NP). This cross-sectional study was established in 2015–2017 in a tertiary reference center to the CF treatment, Brasilia, Brazil. Sample included 30 children volunteers with CRS related to CF (n = 16) and control subjects (n = 14). Epidemiological and clinical data were compared. Collection of 15 mL of peripheral blood and nasal endoscopy to identify the presence or absence of nasal polyps (NP) were performed. Phagocytosis of Saccharomyces cerevisiae by pathogen-associated molecular pattern receptors and opsonin receptors was assessed. Superoxide anion production was evaluated. The control group showed a higher phagocytic index to monocytes and neutrophils than to the CF or CF+CRS with NP groups [Kruskal-Wallis p = 0.0025] when phagocytosis were evaluated by pathogen-associated molecular pattern receptors (5 yeasts/cell). The phagocytic index of the CF+CRS without NP group was higher than in the CF+CRS with NP group (Kruskal-Wallis p = 0.0168). In the control group, the percentage of phagocytes involved in phagocytosis and superoxide anion production (74.0 ± 9.6%) were higher in all CF groups (p < 0,0001). The innate immune response, represented by phagocytic activity and superoxide anion production by monocytes and neutrophils was more impaired in patients with CF related or not related to CRS than in the control group. However, the phagocytic function of patients without NP showed less impairment.
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Affiliation(s)
- Gustavo L. Rezende
- Hospital de Base, Brasília, Federal District, Brazil
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- Nucleus of Research in Applied Morphology and Immunology, Morphology, Faculty of Medicine, University de Brasília, Brasília, Federal District, Brazil
- * E-mail:
| | - Marcio Nakanishi
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- Department of Otolaryngology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- D’Or Institute for Research and Education (IDOR), Brasília, Federal District, Brazil
| | - Shirley C. P. Couto
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
| | - Carmen L. F. S. Martins
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- Department of Pediatric, Faculty of Medicine, University of Brasilia, Brasilia, Distrito Federal, Brazil
| | - André L. L. Sampaio
- Department of Otolaryngology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
| | - Lucas F. F. Albuquerque
- Nucleus of Research in Applied Morphology and Immunology, Morphology, Faculty of Medicine, University de Brasília, Brasília, Federal District, Brazil
| | - Selma A. S. Kückelhaus
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- Nucleus of Research in Applied Morphology and Immunology, Morphology, Faculty of Medicine, University de Brasília, Brasília, Federal District, Brazil
| | - Maria I. Muniz-Junqueira
- Laboratory of Cellular Immunology, Pathology, Faculty of Medicine, University of Brasilia, Brasília, Federal District, Brazil
- Nucleus of Research in Applied Morphology and Immunology, Morphology, Faculty of Medicine, University de Brasília, Brasília, Federal District, Brazil
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Poposki JA, Klingler AI, Stevens WW, Suh LA, Tan BK, Peters AT, Abdala-Valencia H, Grammer LC, Welch KC, Smith SS, Conley DB, Kern RC, Schleimer RP, Kato A. Elevation of activated neutrophils in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2022; 149:1666-1674. [PMID: 34953792 PMCID: PMC9081139 DOI: 10.1016/j.jaci.2021.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is well characterized by type 2 (T2) inflammation characterized by eosinophilia in Western countries. However, the presence and roles of neutrophils in T2 CRSwNP are poorly understood. OBJECTIVE We sought to clarify accumulation and inflammatory roles of neutrophils in CRSwNP in a Western population. METHODS Sinonasal tissues and nasal lavage fluids were obtained from control patients and patients with CRS, and neutrophil markers were determined by ELISA. The presence of neutrophils in tissue was determined by flow cytometry. The gene expression profiles in neutrophils were determined by RNA sequencing. RESULTS A neutrophil marker elastase was selectively elevated in nasal polyp (NP) tissue, whereas eosinophilic cationic protein (an eosinophil marker) was elevated in both uncinate and NP tissues of CRSwNP patients. Nasal lavage fluid myeloperoxidase (another neutrophil marker) was also significantly elevated in CRSwNP compared to control patients. Neutrophil markers were more greatly elevated in CRSwNP patients with recurrent disease. Flow cytometric analysis confirmed that neutrophil numbers were significantly elevated in NPs compared to control tissues. RNA sequencing analysis found that 344 genes were >3-fold and significantly elevated in NP neutrophils compared to peripheral blood neutrophils. Gene Ontology analysis suggested that the elevated genes in NP neutrophils were significantly associated with activation. Results suggest that neutrophils are accumulated in T2 NP tissues and that accumulated neutrophils are highly activated and contribute to inflammation in NPs. CONCLUSIONS Neutrophils may play a heretofore unrecognized meaningful role in the pathogenesis of CRSwNP in Western countries and may be a potentially important therapeutic target in T2 CRSwNP.
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Affiliation(s)
- Julie A Poposki
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aiko I Klingler
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lydia A Suh
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Hiam Abdala-Valencia
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Leslie C Grammer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stephanie S Smith
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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7
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Lee AJ, Huffmyer JL, Thiele EL, Zeitlin PL, Chatterjee D. The Changing Face of Cystic Fibrosis: An Update for Anesthesiologists. Anesth Analg 2022; 134:1245-1259. [PMID: 35020677 DOI: 10.1213/ane.0000000000005856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cystic fibrosis (CF) is the most common fatal genetic disease in North America. While CF is more common among Whites, it is increasingly being recognized in other races and ethnicities. Although there is no cure, life expectancy has steadily improved, with the median survival exceeding 46 years in the United States. There are now more adults than children with CF in the United States. CF is caused by mutations in a gene that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein, expressed in many epithelial cells. More than 2100 CFTR mutations have been linked to CF, and newer CFTR modulator drugs are being used to improve the production, intracellular processing, and function of the defective CFTR protein. CF is a multisystem disease that affects primarily the lungs, pancreas, hepatobiliary system, and reproductive organs. Anesthesiologists routinely encounter CF patients for various surgical and medical procedures, depending on the age group. This review article focuses on the changing epidemiology of CF, advances in the classification of CFTR mutations, the latest innovations in CFTR modulator therapies, the impact of the coronavirus disease pandemic, and perioperative considerations that anesthesiologists must know while caring for patients with CF.
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Affiliation(s)
- Amy J Lee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Eryn L Thiele
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Pamela L Zeitlin
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Debnath Chatterjee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Kuwata F, Ohnishi H, Yamamoto N, Takezawa T, Yamashita M, Okuyama H, Hayashi Y, Yoshimatsu M, Kitada Y, Tada T, Kobayashi M, Omori K. Transplantation of human iPS cell-derived airway cells on vitrigel membrane into rat nasal cavity. Tissue Eng Part A 2021; 28:586-594. [PMID: 34841888 DOI: 10.1089/ten.tea.2021.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The nasal mucosa functions as a frontline biological defense against various foreign substances and pathogens. Maintaining homeostasis of the nasal epithelium is necessary to promote good health. Nasal epithelia are constantly replaced under normal conditions. However, hereditary diseases, including primary ciliary dyskinesia and cystic fibrosis, can result in intractable dysfunction of the nasal mucosa. Since there is no treatment for this underlying condition, extrinsic manipulation is necessary to recover and maintain nasal epithelia in cases of hereditary diseases. In this study, we explored the use of airway epithelial cells (AECs), including multi-ciliated airway cells (MCACs), derived from human induced pluripotent stem cells (hiPSCs) on porcine atelocollagen vitrigel membranes, as a candidate of a therapeutic method for irreversible nasal epithelial disorders. To confirm the regenerative capacity of iPSC-derived AECs, we transplanted them into nasal cavities of nude rats. Although the transplanted cells were found within cysts isolated from the recipient nasal respiratory epithelia, they survived in some rats. Furthermore, the surviving cells were composed of multiple cell types similar to the human airway epithelia. The results could contribute to the development of novel transplantation-related technologies for the treatment of severe irreversible nasal epithelial disorders.
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Affiliation(s)
- Fumihiko Kuwata
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Hiroe Ohnishi
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Norio Yamamoto
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan, 606-8501;
| | - Toshiaki Takezawa
- Institute of Agrobiological Sciences, National Agriculture and Food Research Organization, Division of Biotechnology, Ohwashi 1-2, Tsukuba, Ibaraki, Japan, 305-8634;
| | - Masaru Yamashita
- Kagoshima University Graduate School of Medicine and Dental Sciences, 208512, Kagoshima, Kagoshima, Japan;
| | - Hideaki Okuyama
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Yasuyuki Hayashi
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Masayoshi Yoshimatsu
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Yuji Kitada
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
| | - Takeshi Tada
- Jikei University School of Medicine, 12839, Minato-ku, Tokyo, Japan;
| | - Masayoshi Kobayashi
- Mie University Graduate School of Medicine Faculty of Medicine, 38072, Otolaryngology, Head and Neck Surgery, Tsu, Mie, Japan;
| | - Koichi Omori
- Kyoto University Graduate School of Medicine Faculty of Medicine, 38049, Otolaryngology, Head and Neck Surgery, Kyoto, Japan;
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9
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Tuli JF, Ramezanpour M, Cooksley C, Psaltis AJ, Wormald P, Vreugde S. Association between mucosal barrier disruption by Pseudomonas aeruginosa exoproteins and asthma in patients with chronic rhinosinusitis. Allergy 2021; 76:3459-3469. [PMID: 34033126 DOI: 10.1111/all.14959] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common chronic respiratory condition, frequently associated with asthma and affecting the majority of cystic fibrosis (CF) patients. Pseudomonas aeruginosa infections and biofilms have been implicated in recalcitrant CRS. One of the mechanisms of action for bacteria in CRS and CF is mucosal barrier disruption by secreted products that contribute to the inflammation. However, the role of biofilm and planktonic forms of P. aeruginosa in this process is not known. The aim is to determine the effect of P. aeruginosa exoproteins isolated from CF and non-CF CRS patients on the mucosal barrier. METHODS Exoproteins from 40 P. aeruginosa isolates were collected in planktonic and biofilm forms and applied to air-liquid interface (ALI) cultures of primary human nasal epithelial cells (HNECs). Mucosal barrier integrity was evaluated by transepithelial electrical resistance (TEER), passage of FITC-dextrans and immunofluorescence of tight junction proteins. Cytotoxicity assays were performed to measure cell viability, and IL-6 ELISA was carried out to evaluate pro-inflammatory effects. RESULTS Planktonic exoproteins from 20/40 (50%) clinical isolates had a significant detrimental effect on the barrier and significantly increased IL-6 production. Barrier disruption was characterized by a reduced TEER, increased permeability of FITC-dextrans and discontinuous immunolocalization of tight junction proteins and was significantly more prevalent in isolates harvested from patients with comorbid asthma (P < .05). CONCLUSION Exoproteins from planktonic P. aeruginosa clinical isolates from asthmatic CRS patients have detrimental effects on the mucosal barrier and induce IL-6 production potentially contributing to the mucosal inflammation in CRS patients.
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Affiliation(s)
- Jannatul Ferdoush Tuli
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
| | - Mahnaz Ramezanpour
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
| | - Clare Cooksley
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
| | - Alkis James Psaltis
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
| | - Peter‐John Wormald
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
| | - Sarah Vreugde
- Department of Surgery‐Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide South Australia Australia
- Central Adelaide Local Health Network The Queen Elizabeth Hospital Woodville South South Australia Australia
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10
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Chen Q, Shen Y, Zheng J. A review of cystic fibrosis: Basic and clinical aspects. Animal Model Exp Med 2021; 4:220-232. [PMID: 34557648 PMCID: PMC8446696 DOI: 10.1002/ame2.12180] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022] Open
Abstract
Cystic fibrosis is an autosomal recessive disease caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). Here we summarize, at the basic descriptive level, clinical and genetic characteristics of cystic fibrosis gene mutations, while emphasizing differences between CF mutations found in Chinese pediatric CF patients compared to those found in Caucasian CF patients. In addition, we describe animal models used to study human cystic fibrosis disease and highlight unique features of each model that mimic specific human CF-associated signs and symptoms. At the clinical level, we summarize CF clinical manifestations and diagnostic, treatment, and prognostic methods to provide clinicians with information toward reducing CF misdiagnosis and missed diagnosis rates.
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Affiliation(s)
- Qionghua Chen
- Department No. 2 of Respiratory Medicine Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
- Department of Respiratory Medicine Quanzhou Children's Hospital Fujian Province Quanzhou China
| | - Yuelin Shen
- Department No. 2 of Respiratory Medicine Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
| | - Jingyang Zheng
- Department of Respiratory Medicine Quanzhou Children's Hospital Fujian Province Quanzhou China
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11
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Phenotypes of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1505-1511. [PMID: 32389275 DOI: 10.1016/j.jaip.2019.12.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex heterogeneous disease with different phenotypes and endotypes. Recent advances in our understanding of the pathogenetic mechanisms of CRS endotypes have led to the introduction of effective biologic agents for CRS management. Traditionally, CRS phenotypes have been divided into with or without nasal polyps depending on the presence of polyps. Although this classification does not reflect the various endotypes that are recently emerging, it is simple and easily recognized by clinicians. Other phenotypes of CRS are fungal rhinosinusitis (including invasive and noninvasive subtypes), infectious rhinosinusitis, aspirin-exacerbated respiratory disease, cystic fibrosis, pediatric CRS, and CRS associated with systemic diseases. This article reviews the diagnostic approaches and up-to-date treatment strategies for each CRS phenotype with the hope that a better understanding of endotypes will result in a more scientific understanding of phenotypes and precise, personalized treatments.
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12
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Eschenhagen P, Schwarz C. [Many patients with cystic fibrosis have a better quality of life now]. MMW Fortschr Med 2021; 163:74-81. [PMID: 33950452 DOI: 10.1007/s15006-021-9804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis. Ann Am Thorac Soc 2021; 17:714-723. [PMID: 32142375 DOI: 10.1513/annalsats.201910-777oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic rhinosinusitis (CRS) contributes to disease burden of patients with cystic fibrosis (CF). However, its onset and progression in infants and preschool children with CF remain poorly understood.Objectives: To determine the prevalence and extent of CRS in young children with CF using magnetic resonance imaging (MRI).Methods: MRI was performed in sedation in 67 infants and preschool children with CF (mean age 2.3 ± 2.1 yr; range 0-6 yr) and 30 non-CF control subjects (3.5 ± 2.0 yr; range 0-6 yr). Paranasal sinus dimensions and structural abnormalities, including mucosal swelling; mucopyoceles; and nasal polyps of the maxillary, frontal, sphenoid, and ethmoid sinuses; and, in addition, medial maxillary sinus wall deformation, were assessed using a dedicated CRS MRI scoring system.Results: Pneumatization and dimensions of paranasal sinuses did not differ between the two groups. MRI detected an increased prevalence of mucosal swelling (83% vs. 17%; P < 0.001), mucopyoceles (75% vs. 2%; P < 0.001), polyps (26% vs. 7%; P < 0.001), and maxillary sinus wall deformation (68% vs. 2%; P < 0.001) in infants and preschool children with CF compared with age-matched control subjects. Furthermore, the extent of these abnormalities was also increased with a MRI sum score of 22.9 ± 10.9 in CF compared with 4.5 ± 7.6 in non-CF control subjects (P < 0.001).Conclusions: MRI detected normal dimensions of paranasal sinuses, and a high prevalence and severity of paranasal sinus abnormalities due to CRS in infants and preschool children with CF without radiation exposure. Our results support the development of MRI for sensitive noninvasive diagnosis and monitoring of CRS in young children with CF, and as outcome measures for clinical trials.Clinical trial registered with www.clinicaltrials.gov (NCT00760071).
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14
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Douglas JE, Civantos AM, Locke TB, Sweis AM, Hadjiliadis D, Hong G, Dorgan DJ, Kohanski MA, Palmer JN, Adappa ND. Impact of novel CFTR modulator on sinonasal quality of life in adult patients with cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:201-203. [PMID: 33070454 DOI: 10.1002/alr.22716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Denis Hadjiliadis
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Dorgan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
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15
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Abstract
CLINICAL ISSUE Disease severity and mortality in patients with cystic fibrosis (CF) is mainly determined by (progressive) pulmonary lung disease. Early diagnosis and therapy are important and of prognostic value to conserve lung function. STANDARD RADIOLOGICAL METHODS Primary imaging techniques for lung imaging are x‑ray and computed tomography (CT) to monitor disease severity and regional distribution. METHODICAL INNOVATIONS Radiation-free imaging techniques such as magnetic resonance imaging (MRI) have gained interest over the last decade in order to prevent radiation damage. PERFORMANCE The main findings of CF lung disease are airway wall thickening, bronchiectasis, and mucus plugging, which are found in up to 60% of preschool age children. Pleural abnormalities and consolidations are often associated with pulmonary exacerbation. Young CF patients often show a mosaic pattern as functional changes and also perfusion defects can be seen from birth in 50% of CF patients by contrast-enhanced perfusion imaging, and in up to 90% of adult patients, with varying degrees of severity. Dilated bronchial arteries indicate an increased risk for hemoptysis. ACHIEVEMENTS Proton MRI is the sole imaging technique that can show structural and functional lung changes in one examination. Structured assessment using a scoring system helps to systematically grade the extent and severity of all CF-associated changes. CONCLUSIONS Lung MRI for cystic fibrosis has been recently established as a clinical standard examination and is routinely performed at experienced centers. More recently, it has also been used as an endpoint within the framework of clinical studies.
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16
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DiMango E, Spielman DB, Overdevest J, Keating C, Francis SF, Dansky D, Gudis DA. Effect of highly effective modulator therapy on quality of life in adults with cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:75-78. [PMID: 32985756 DOI: 10.1002/alr.22700] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/30/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elexacaftor/tezacaftor/ivacaftor is a highly effective modulator that improves function of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, resulting in improved pulmonary function in patients with cystic fibrosis (CF). We hypothesize that improvements in lung function are associated with improvements in health-related quality of life and sinonasal health. The aim of this study is to measure the effect of elexacaftor/tezacaftor/ivacaftor on patient-reported sinonasal and overall quality of life, and to determine the relationship between changes in these 2 outcome measures. METHODS A prospective cohort study was conducted at an accredited adult CF care center. Participants completed the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a validated patient-reported outcome metric for CF patients, at baseline and at 3 months after initiation of elexacaftor/tezacaftor/ivacaftor. RESULTS Forty-three individuals completed the study. There was significant improvement in nearly all domains of the SNOT-22 and CFQ-R after 3 months of therapy. SNOT-22 improved from 34.8 to 24.4 (p = 0.000003). Mean baseline FEV-1 improved from 65% to 76% predicted (p = 0.0000005). The greatest effect was seen in those participants previously taking modulator therapy. Linear regression between the change in SNOT-22 individual domains and the CFQ-R respiratory domain revealed the strongest correlation between the extranasal domain score and the respiratory domain of the CFQ-R (R2 = 0.24). CONCLUSION CF patients taking elexacaftor/tezacaftor/ivacaftor experience a significant improvement in both sinonasal and health-related quality of life.
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Affiliation(s)
- Emily DiMango
- Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Jonathan Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Claire Keating
- Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Sarah Fracasso Francis
- Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Dansky
- Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
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17
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Jayawardena ADL, Fracchia MS, Bartley BL, Yonker LM, Lapey A, Virgin F, Hartnick CJ. Working towards consensus in the management of pediatric chronic rhinosinusitis in cystic fibrosis. Int J Pediatr Otorhinolaryngol 2020; 135:110047. [PMID: 32446041 DOI: 10.1016/j.ijporl.2020.110047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The prevalence of chronic rhinosinusitis (CRS), defined by mucosal thickening on imaging, approaches 100% in the cystic fibrosis (CF) population. CRS is associated with significant morbidity in CF, including its ability to trigger pulmonary exacerbations. CRS in CF is typically managed by pediatricians, otolaryngologists and pulmonologists. This survey evaluates the variance in practice patterns of CRS in CF amongst specialists. METHODS This is a cross-sectional, electronic survey in which maximum variation purposive sampling was used by a multi-disciplinary group of pediatric, otolaryngology and pulmonology providers in order to select a survey population with expertise in CRS in CF patients. The survey was distributed to 381 practitioners from September to October 2019. RESULTS 175 participants responded (45% response rate). Ten (of 54) statements achieved 75% consensus agreement. Consensus statements included: The decision to pursue surgical intervention for CRS in CF is a multi-disciplinary approach (94%; n = 146); maximal medical management should include nasal saline irrigation (93%; n = 142), topical steroids (75%; n = 117), maximal medical management should not include intravenous steroids (79%; n = 122); image guidance in surgery is necessary for all surgery involving the frontal sinuses (77%; n = 43), and all revision surgery(80%, n = 45); the appropriate setting for sinus surgery in a CF patient varies depending on patient presentation (89%; n = 133); post-operative regimen should include nasal saline (93%; n = 137); but does depend on the severity of disease discovered intra-operatively (84%; n = 124); post-operative antibiotics should be guided by intra-operative culture data (82%; n = 121). CONCLUSIONS There is a great deal of variation amongst specialists in the treatment of CRS in CF, however 10 statements met consensus criteria and should be considered when forming clinical care guidelines in this population.
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Affiliation(s)
- Asitha D L Jayawardena
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology Head and Neck Surgery, Boston, MA, USA
| | - M Shannon Fracchia
- Massachusetts General Hospital, Department of Pediatric Pulmonology, Boston, MA, USA
| | - Bethany L Bartley
- Massachusetts General Hospital, Department of Pediatric Pulmonology, Boston, MA, USA
| | - Lael M Yonker
- Massachusetts General Hospital, Department of Pediatric Pulmonology, Boston, MA, USA
| | - Allen Lapey
- Massachusetts General Hospital, Department of Pediatric Pulmonology, Boston, MA, USA
| | - Frank Virgin
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher J Hartnick
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology Head and Neck Surgery, Boston, MA, USA.
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18
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Gostelie R, Stegeman I, Berkers G, Bittermann J, Ligtenberg-van der Drift I, van Kipshagen PJ, de Winter - de Groot K, Speleman L. The impact of ivacaftor on sinonasal pathology in S1251N-mediated cystic fibrosis patients. PLoS One 2020; 15:e0235638. [PMID: 32687499 PMCID: PMC7371187 DOI: 10.1371/journal.pone.0235638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Sinonasal symptoms in patients suffering from cystic fibrosis can negatively influence the quality of life and sinuses can be a niche for pathogens causing infection and inflammation leading to a decrease of lung function. Ivacaftor, a potentiator of the Cystic Fibrosis Transmembrane Conductance Regulator protein, has shown improvement in pulmonary function in cystic fibrosis patients with different forms of class III gating mutations. However, the effects of ivacaftor on sinonasal pathology have hardly been studied. OBJECTIVE To determine the impact of ivacaftor therapy on sinonasal pathology in patients with cystic fibrosis with an S1251N mutation. DESIGN Prospective observational mono-center cohort study, between June 2015 and December 2016. SETTING A tertiary referral center in Utrecht, The Netherlands. PARTICIPANTS Eight patients with cystic fibrosis with an S1251N mutation, treated with the potentiator ivacaftor were investigated. EXPOSURES Ivacaftor (Kalydeco, VX-770) therapy. Computed tomography imaging of paranasal sinuses. Nasal nitric oxide concentration measurements and nasal endoscopy. MAIN OUTCOMES AND MEASURES Primary outcome is opacification of paranasal sinuses examined with computed tomography scan analysis and scaled by the modified Lund-Mackay score before and one year after treatment. Secondary outcomes are nasal nitric oxide concentration levels, sinonasal symptoms and nasal endoscopic findings before and approximately two months and in some cases one year after treatment. RESULTS Computed tomography scan analysis showed a significant decrease in opacification of the majority of paranasal sinuses comparing the opacification score per paranasal sinus before and after one year of treatment with ivacaftor. Median nasal nitric oxide levels significantly improved from 220.00 (IQR:136.00-341.18) to 462.84 (IQR:233.17-636.25) (p = 0.017) parts per billion. Likewise, the majority of sinonasal symptoms and nasal endoscopic pathology decreased or resolved at two months after the use of ivacaftor. CONCLUSION AND RELEVANCE Ivacaftor appears to improve sinonasal outcome parameters and thereby sinonasal health in patients with cystic fibrosis with an S1251N mutation.
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Affiliation(s)
- Romee Gostelie
- University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Gitte Berkers
- Department of Pediatric Respiratory Medicine and Allergology, Cystic Fibrosis Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Joost Bittermann
- Department of Pediatric Otorhinolaryngology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ivonne Ligtenberg-van der Drift
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Karin de Winter - de Groot
- Department of Pediatric Respiratory Medicine and Allergology, Cystic Fibrosis Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Lucienne Speleman
- Department of Pediatric Otorhinolaryngology, University Medical Center, Utrecht University, Utrecht, The Netherlands
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19
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DiMango E, Overdevest J, Keating C, Francis SF, Dansky D, Gudis D. Effect of highly effective modulator treatment on sinonasal symptoms in cystic fibrosis. J Cyst Fibros 2020; 20:460-463. [PMID: 32694034 DOI: 10.1016/j.jcf.2020.07.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/10/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elexacaftor-tezacaftor-ivacaftor is a highly effective modulator for cystic fibrosis (CF) patients homozygous or heterozygous for F508del. Effects of the drug on sinonasal symptoms have not been studied. METHODS Adult participants were prospectively evaluated at baseline and after three months of treatment using validated questionnaires assessing sinonasal symptoms (SNOT-22) and CF-related quality of life (CFQ-R). RESULTS Forty-three participants completed the study; 23 were taking other CF transmembrane conductance (CFTR) modulators at the time of study participation. There was a significant improvement in mean SNOT-22 from 34.8 (29.4-40, 95% confidence interval) to 24.4 (19.9-29.0) (p = 0.000003) and in the Respiratory domain of the CFQR from 60.6 (57.1-64.1) to 83.3 (79.4-87.2) (p = 0.0000002), both achieving a minimal clinically important difference. Patients previously taking CFTR modulators experienced a greater benefit in sinonasal and respiratory symptoms. CONCLUSIONS Elexacaftor-tezacaftor-ivacaftor is associated with significant improvement in sinonasal symptoms; previous use of CFTR modulators is associated with greater benefit.
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Affiliation(s)
- Emily DiMango
- Columbia University Irving Medical Center Department of Medicine, Pulmonary, Allergy and Critical Care, 622 West 168th Street, New York, New York 10032, United States.
| | - Jonathan Overdevest
- Columbia University Irving Medical Center, Department of Otolaryngology, United States.
| | - Claire Keating
- Columbia University Irving Medical Center Department of Medicine, Pulmonary, Allergy and Critical Care, 622 West 168th Street, New York, New York 10032, United States.
| | - Sarah Fracasso Francis
- Columbia University Irving Medical Center Department of Medicine, Pulmonary, Allergy and Critical Care, 622 West 168th Street, New York, New York 10032, United States.
| | - David Dansky
- Columbia University Irving Medical Center Department of Medicine, Pulmonary, Allergy and Critical Care, 622 West 168th Street, New York, New York 10032, United States.
| | - David Gudis
- Columbia University Irving Medical Center, Department of Otolaryngology, United States.
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20
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Beswick DM, Smith TL, Mace JC, Alt JA, Farrell NF, Ramakrishnan VR, Schlosser RJ, Soler ZM. Ethmoid-to-maxillary opacification ratio: a predictor of postoperative olfaction and outcomes in nasal polyposis? Int Forum Allergy Rhinol 2020; 11:48-57. [PMID: 32558260 DOI: 10.1002/alr.22625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid-to-maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non-type 2 dominant. In this study we explore this factor in North American/type 2-based populations. METHODS Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi-institutional study. The 22-item Sino-Nasal Outcome Test (SNOT-22), Brief Smell Identification Test (BSIT), and Lund-Kennedy (LK) endoscopic scores were obtained pre- and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund-Mackay (LM) scores. RESULTS On average, significant within-subject postoperative improvement was found in all patients for SNOT-22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = -0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT-22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ2 = 9.96, p = 0.041). CONCLUSION Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT-22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non-type 2) in patients with CRS.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, CO
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Nyssa F Farrell
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | | | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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21
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Spillinger A, Low CM, Smith BM, Stokken JK, O'Brien EK, Choby G. Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant. World J Otorhinolaryngol Head Neck Surg 2020; 7:139-145. [PMID: 33997724 PMCID: PMC8103524 DOI: 10.1016/j.wjorl.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study aims to describe presenting characteristics of patients diagnosed with non-invasive chronic rhinosinusitis (CRS) following liver or kidney transplant and determine factors associated with disease-related complications, selection of endoscopic sinus surgery (ESS), and disease resolution in this population. Study design Retrospective chart review. Setting An academic tertiary care center (Mayo Clinic, Rochester, Minnesota). Subjects and methods Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified. Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications, selection of ESS, and disease resolution. Results Fifty-seven patients met inclusion criteria. No patients developed intraorbital or intracranial complications of their CRS. Multivariate modeling demonstrated that the presence of polyps (P = 0.036) was associated with undergoing ESS within one year of presentation. A higher Lund–Mackay (LM) computed tomography score (P = 0.023) and older age (P = 0.018) were significantly associated with decreased disease resolution. No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort. Conclusion The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought. For liver- and kidney-recipients stable on immunosuppressive medication for many years, prognostic factors for CRS may mirror those for immunocompetent patients.
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Affiliation(s)
- Aviv Spillinger
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Byron M Smith
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, 55905, USA
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22
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Majima S, Wakahara K, Nishio T, Nishio N, Teranishi M, Iwano S, Hirakawa A, Hashimoto N, Sone M, Hasegawa Y. Bronchial wall thickening is associated with severity of chronic rhinosinusitis. Respir Med 2020; 170:106024. [PMID: 32843166 DOI: 10.1016/j.rmed.2020.106024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Though the relationship between chronic rhinosinusitis (CRS) and lower airway diseases is well recognized, the impact of CRS on bronchial wall structure has not been elucidated. Here, we evaluated the bronchial wall structure of CRS patients with or without diagnosed airway diseases by three-dimensional computed tomography (3D-CT). METHODS Subjects who underwent both chest CT and sinus CT within a year were recruited from consecutive medical records. CRS was defined as a Lund-Mackay score (LMS) of over 5 points. Airway dimensions were measured using validated software. Standard blood tests and pulmonary function tests were performed, and their correlation with airway thickness was examined. RESULTS One-hundred-seventy-two patients were recruited (93 CRS subjects and 79 non-CRS subjects). The bronchial walls of CRS subjects were significantly thicker than those of non-CRS subjects. CRS and asthma were related to bronchial wall thickening by multivariate linear regression analysis adjusted for age, smoking status, and chest symptoms. In addition, LMS was significantly correlated with bronchial wall thickening. CONCLUSION Airway walls in CRS subjects were thicker than those in non-CRS subjects and associated with the severity of CRS. These data indicate strong relationship between upper and lower airways regardless of chest symptoms or diagnosed airway diseases.
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Affiliation(s)
- Suguru Majima
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tomoko Nishio
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Hongo, Tokyo, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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23
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Endophenotyping Oxaliplatin Hypersensitivity: Personalizing Desensitization to the Atypical Platin. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1668-1680.e2. [DOI: 10.1016/j.jaip.2020.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
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24
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Okafor S, Kelly KM, Halderman AA. Management of Sinusitis in the Cystic Fibrosis Patient. Immunol Allergy Clin North Am 2020; 40:371-383. [DOI: 10.1016/j.iac.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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25
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Mauch RM, Hentschel J, Aanaes K, Barucha A, Nolasco da Silva MT, Levy CE, Høiby N, Mainz JG. Antibody response against Pseudomonas aeruginosa and its relationship with immune mediators in the upper and lower airways of cystic fibrosis patients. Pediatr Pulmonol 2020; 55:959-967. [PMID: 32022432 DOI: 10.1002/ppul.24671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The upper airways (UAW) are a niche and a reservoir of Pseudomonas aeruginosa strains that cause chronic infection of the lower airways (LAW) in cystic fibrosis (CF). Here, we assessed the role of anti-P. aeruginosa immunoglobulin A (IgA) and IgG antibodies in upper and lower airway infections in cystic fibrosis patients. METHODS Nasal lavage fluid and induced sputum samples of 40 CF patients were microbiologically cultured. We searched for correlations between anti-P. aeruginosa IgA and IgG levels, measured by enzyme-linked immunosorbent assay (optical density), and unspecific immune mediators in both specimens. RESULTS Anti-P. aeruginosa IgA (median optical density: 0.953 vs 0.298) and IgG (0.120 vs 0.059) were significantly higher in nasal lavage than in sputum, but not significantly different between patients with and without chronic P. aeruginosa infection in UAW. Matrix metallopeptidase-9 (MMP-9) in nasal lavage and neutrophil elastase (NE) in sputum were predictors of IgA in nasal lavage and IgA in sputum, respectively. IgA was a predictor of myeloperoxidase (MPO) in nasal lavage. Tissue inhibitor of metalloproteinases-1 (TIMP-1) was a predictor of IgG in sputum. IgG, TIMP-1, and NE in sputum were predictors of IgG in nasal lavage. CONCLUSION The anti-P. aeruginosa IgA response was more prominent in CF patients' UAW, indicating a lower degree of inflammatory responses. Proteases may play a role in the anti-P. aeruginosa humoral response in the upper and LAW, and anti-P. aeruginosa IgG may be involved in the crosstalk between upper and lower airways in cystic fibrosis patients.
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Affiliation(s)
- Renan M Mauch
- Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Julia Hentschel
- Institute of Human Genetics, University of Leipzig, Leipzig, Germany
| | - Kasper Aanaes
- Department of Oto-Rhino-Laryngology, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
| | - Anton Barucha
- Department of Pediatric Pulmonology/Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Marcos T Nolasco da Silva
- Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.,Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos E Levy
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Niels Høiby
- Department of International Health, Immunology, and Microbiology, Costerton Biofilm Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jochen G Mainz
- Department of Pediatric Pulmonology/Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany.,Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
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26
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Laulajainen-Hongisto A, Toppila-Salmi SK, Luukkainen A, Kern R. Airway Epithelial Dynamics in Allergy and Related Chronic Inflammatory Airway Diseases. Front Cell Dev Biol 2020; 8:204. [PMID: 32292784 PMCID: PMC7118214 DOI: 10.3389/fcell.2020.00204] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
Allergic rhinitis, chronic rhinosinusitis, and asthma are highly prevalent, multifactorial chronic airway diseases. Several environmental and genetic factors affect airway epithelial dynamics leading to activation of inflammatory mechanisms in the airways. This review links environmental factors to host epithelial immunity in airway diseases. Understanding altered homeostasis of the airway epithelium might provide important targets for diagnostics and therapy of chronic airway diseases.
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Affiliation(s)
- Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
| | - Sanna Katriina Toppila-Salmi
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annika Luukkainen
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
| | - Robert Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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27
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Staudacher AG, Peters AT, Kato A, Stevens WW. Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2020; 124:318-325. [PMID: 32007571 DOI: 10.1016/j.anai.2020.01.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE With the advent of new treatment options for Chronic Rhinosinusitis (CRS) comes the ability for physicians to provide more individualized patient care. Physicians are now tasked with identifying who may be the best candidate for a particular therapy. In this review, existing biomarkers and potentially new methods that could guide treatment choices in CRS patients will be discussed. DATA SOURCES Published literature obtained through PubMed searches. STUDY SELECTION Studies relevant to inflammatory endotypes, phenotypes, and biomarkers in CRS were included. RESULTS Currently, there are no clinically validated tools that determine the best therapeutic modality for CRS patients with or without nasal polyps (CRSwNP or CRSsNP). Patients with CRS can be classified into three endotypes based on the presence of type 1, type 2, or type 3 inflammation. CRS endotypes can be influenced by age and geographic location. Clinical application however may be limited since endotyping current requires basic research laboratory support. Clinical symptoms may also predict inflammatory endotypes with smell loss being indicative of type 2 inflammation. Numbers of tissue and/or peripheral eosinophils as well as levels of IgE may predict disease severity in CRSwNP but not necessarily treatment responses. Unique clinical phenotypes or biomarkers are especially lacking that predict type 1 or type 3 inflammation in CRSwNP or type 1, type 2, or type 3 inflammation in CRSsNP. CONCLUSION While significant progress has been made in characterizing endotypes, phenotypes, and biomarkers in CRS, additional studies are needed to determine if and how these factors could assist physicians in providing more individualized clinical care.
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Affiliation(s)
- Anna G Staudacher
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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28
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Kisiel M, Sjölander I, Klar A, Asplund Stenkvist M, Laurell G. Development of bacterial resistance during treatment with topical gentamicin for chronic rhinosinusitis in patients with cystic fibrosis and primary ciliary dyskinesis. Retrospective case series. Otolaryngol Pol 2020; 74:33-40. [PMID: 32398382 DOI: 10.5604/01.3001.0013.7851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) is still a challenge. At our institution we have used gentamycin nasal spray, extemporaneously produced, for prophylactic treatment of moderate-to-severe CRS. The aim of this study was to investigate the gentamycin susceptibility of bacteria in sputum samples in CF and PCD patients treated for CRS. METHODOLOGY Patients with CF and PCD who were prescribed gentamycin nasal spray for CRS and had sputum bacterial cultures taken pre-treatment and followed-up at least once after ≥6 months were retrospectively included. Microbiological data were descriptively analysed in terms of bacterial species and resistance to gentamycin. RESULTS A case series of 17 CF and 12 PCD patients passed the inclusion criteria. Of those cases, three (18%) CF patients and one (8%) PCD patient developed resistance to gentamycin during treatment with gentamycin nasal spray. In all four cases, the resistant bacterial isolates were <i>P. aeruginosa</i>. Additionally, two CF patients already had <i>P. aeruginosa </i> isolates resistant to gentamycin in the pre-treatment culture. In further two CF patients, the multi-resistant <i>Burgdorferi cepacia </i>complex, including gentamycin resistance, was identified. <i>P. aeruginosa </i> and <i>S. aureus </i> in CF and <i>P. aeruginosa</i> and <i>H. influenza </i> in PCD were the predominant bacterial species. CONCLUSIONS The study showed that there was moderate incidence of gentamycin resistance in CF and PCD patients at our institution. However, further prospective studies are needed to confirm the outcomes.
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Affiliation(s)
- Marta Kisiel
- Environmental and Occupational Medicine, Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Isabella Sjölander
- Department of ENT, Surgical Science, Uppsala University Hospital, Uppsala, Sweden
| | - Agnes Klar
- Tissue Biology Research Unit, University Children's Hospital Zurich, Switzerland
| | | | - Göran Laurell
- Department of ENT, Surgical Science, Uppsala University Hospital, Uppsala, Sweden
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29
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Farzal Z, Dean KM, Sreenath SB, Hodge SE, Thorp BD, Ebert Jr CS, Zanation AM, Senior BA, Kimple AJ. Streamlining care in cystic fibrosis: survey of otolaryngologist, pulmonologist, and patient experiences. Int Forum Allergy Rhinol 2020; 10:591-603. [DOI: 10.1002/alr.22522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Zainab Farzal
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Kelly M. Dean
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Satyan B. Sreenath
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Sarah E. Hodge
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Brian D. Thorp
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Charles S. Ebert Jr
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Adam M. Zanation
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Brent A. Senior
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
| | - Adam J. Kimple
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill NC
- Marsico Lung Institute/Cystic Fibrosis CenterUniversity of North Carolina at Chapel Hill Chapel Hill NC
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30
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Bhatt JM, Muhonen EG, Meier M, Sagel SD, Chan KH. Rhinosinusitis in Pediatric Primary Ciliary Dyskinesia: Impact of Disease. Otolaryngol Head Neck Surg 2019; 161:877-880. [DOI: 10.1177/0194599819874842] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives Primary ciliary dyskinesia (PCD) is a genetic disorder characterized by abnormal respiratory cilia ultrastructure and/or function causing defective mucociliary clearance. We investigated the extent and severity of rhinosinusitis in a large cohort of children with PCD and explored associations among risk factors, including genotype and sinus disease. Study Design Retrospective chart review. Setting Tertiary academic children’s hospital. Subjects and Methods A review was conducted with a patient registry at the PCD Foundation Center at our institution. Demographic, imaging, clinical, and operative data were reviewed through the institutional electronic health record system. Results Fifty-four subjects were identified with mean and median age at diagnosis of 5.2 and 4.0 years. The male:female ratio was 35%:65%. Sinus symptoms were present in 46 (85%) subjects, 22 of whom had chronic rhinosinusitis. Nineteen (35%) subjects underwent operative intervention, consisting of endoscopic sinus surgery (ESS; 16 patients) and maxillary lavage (3 patients). Nineteen subjects underwent adenoidectomy for PCD-related indications. Five sinus-related admissions in 3 subjects were noted during the study period, and no complication of rhinosinusitis occurred in the cohort. Genetic test results were available in 27 subjects, in whom 23 (85%) had biallelic mutations in a PCD gene. Demographic factors, Lund-Mackay score, and PCD genotype were not found to be predictors for ESS or hospitalization in our cohort. Conclusion While rhinosinusitis was common in our PCD cohort, most patients did not require ESS. Since complications of rhinosinusitis were uncommon, we recommend judicious surgical management tailored to the patient’s symptoms.
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Affiliation(s)
- Jay M. Bhatt
- Children’s Hospital Orange County, Orange, California, USA
| | | | - Maxene Meier
- Children’s Hospital Center for Research in Outcomes for Children’s Surgery, Children’s Hospital Center for Children’s Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Scott D. Sagel
- Children’s Hospital Colorado, Aurora, Colorado, USA
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Kenny H. Chan
- Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, Colorado
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31
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Purnell PR, Addicks BL, Zalzal HG, Shapiro S, Wen S, Ramadan HH, Setola V, Siderovski DP. Single Nucleotide Polymorphisms in Chemosensory Pathway Genes GNB3, TAS2R19, and TAS2R38 Are Associated with Chronic Rhinosinusitis. Int Arch Allergy Immunol 2019; 180:72-78. [PMID: 31137020 DOI: 10.1159/000499875] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a multifaceted disease with a significant genetic component. The importance of taste receptor signaling has recently been highlighted in CRS; single nucleotide polymorphisms (SNPs) of bitter tastant-responsive G-protein-coupled receptors have been linked with CRS and with altered innate immune responses to multiple bacterially derived signals. OBJECTIVE To determine in CRS the frequency of six SNPs in genes with known bitter tastant signaling function. METHODS Genomic DNA was isolated from 74 CRS volunteers in West Virginia, and allele frequency was determined and compared with demographically matched data from the 1,000 Genomes database. RESULTS For two SNPs in a gene recently associated with bitterant signaling regulation, RGS21, there were no associations with CRS (although the frequency of the minor allele of RGS21, rs7528947, was seen to increase with increasing Lund-Mackay CT staging score). Two TAS2R bitter taste receptor gene variants (TAS2R19 rs10772420 and TAS2R38 rs713598), identified in prior CRS genetics studies, were found to have similar associations in this study. CONCLUSION Unique to our study is the establishment of an association between CRS in this patient population and GNB3 SNP rs5443, a variation in an established G protein component downstream of bitterant receptor signal transduction.
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Affiliation(s)
- Phillip R Purnell
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Benjamin L Addicks
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Habib G Zalzal
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Scott Shapiro
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Vincent Setola
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Department of Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - David P Siderovski
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia, USA,
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32
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Abstract
There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or colonization) by specific pathogens. This review explores the associations between rhinosinusitis and asthma, with particular emphasis placed on the role of infections and inflammation.
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Affiliation(s)
- Anna G Staudacher
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA.
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33
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Sedaghat AR, Hoehle LP, Gray ST. Chronic rhinosinusitis control from the patient and physician perspectives. Laryngoscope Investig Otolaryngol 2018; 3:419-433. [PMID: 30599025 PMCID: PMC6302712 DOI: 10.1002/lio2.208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient-reported and physician-rated CRS disease control. STUDY TYPE Cross-sectional. METHODS A total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and also reported the number of sinus infections, CRS-related antibiotic courses taken, CRS-related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund-Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT-22 score (as well as SNOT-22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS-related antibiotics, CRS-related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT-22 score, endoscopy score, sinus infections, CRS-related antibiotic usage, CRS-related oral corticosteroid usage, and lost productivity due to CRS) and patient-reported CRS control as well as mean physician-rated CRS control. RESULTS Patient-reported global CRS control was associated only with SNOT-22 (adjusted relative risk [RR] = 0.99, 95% CI: 0.98-0.99, P < .001) but no other CRS disease characteristic. Patient-reported CRS control was specifically associated only with nasal symptoms and not extra-nasal symptoms of CRS. Physician-rated CRS control was associated with SNOT-22 score (adjusted RR [for each 1-unit increase of SNOT-22] = 0.99, 95% CI: 0.98-0.99, P < .001), number of acute bacterial CRS exacerbations-reflected by number of antibiotic courses taken (or sinus infections)-in the last 3 months (adjusted RR = 0.89, 95% CI: 0.82-0.98, P = .014) and the number of CRS-related oral corticosteroid courses taken in the last 3 months (adjusted RR = 0.87, 95% CI: 0.78-0.97, P = .012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician-rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS. CONCLUSIONS Patients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra-nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS-related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS-related oral corticosteroid use in the determination of global CRS control. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Ahmad R. Sedaghat
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMassachusettsU.S.A
- Department of Otolaryngology and Communications EnhancementBoston Children's HospitalBostonMassachusettsU.S.A
| | - Lloyd P. Hoehle
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
| | - Stacey T. Gray
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsU.S.A
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Banoub RG, Hoehle LP, Phillips KM, Schulman BJ, Caradonna DS, Gray ST, Sedaghat AR. Depressed Mood Modulates Impact of Chronic Rhinosinusitis Symptoms on Quality of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2098-2105. [DOI: 10.1016/j.jaip.2018.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 02/09/2023]
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Kapucu I, Kocak M, Kontzialis M. Intracerebral Abscess: An Uncommon Complication of Cystic Fibrosis. J Emerg Med 2018; 55:e47-e49. [PMID: 29941375 DOI: 10.1016/j.jemermed.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Irem Kapucu
- Division of Neuroradiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Mehmet Kocak
- Division of Neuroradiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Marinos Kontzialis
- Division of Neuroradiology, Department of Radiology, Rush University Medical Center, Chicago, Illinois
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Banoub RG, Phillips KM, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Relationship between chronic rhinosinusitis exacerbation frequency and asthma control. Laryngoscope 2017; 128:1033-1038. [PMID: 28963721 DOI: 10.1002/lary.26901] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the association between the frequency of acute chronic rhinosinusitis (CRS) exacerbations (AECRS) and the degree of asthma control in asthmatic CRS patients. STUDY DESIGN Cross-sectional study. METHODS We prospectively recruited 108 asthmatic CRS patients as participants. Asthma control was assessed using the Asthma Control Test (ACT). The frequency of AECRS was assessed using three previously described indirect metrics for AECRS: the frequency of patient-reported sinus infections, CRS-related antibiotics use, and CRS-related oral corticosteroids use in the last 3 months. CRS symptom severity was measured using the 22-item Sinonasal Outcome Test (SNOT-22). Associations between ACT score and metrics for AECRS were performed using linear regression while controlling for clinical and demographic characteristics, including SNOT-22 score. RESULTS ACT score was significantly and negatively associated with the frequency of patient-reported sinus infections (adjusted linear regression coefficient [β] = -1.2, 95% confidence interval [CI]: -2.3 to -0.1, P = .033), CRS-related antibiotics courses (adjusted β = -1.4, 95% CI: -2.3 to -0.5, P = .004), and CRS-related oral corticosteroid courses (adjusted β = -1.5, 95% CI: -2.5 to -0.5, P = .004) in the last 3 months, independent of characteristics including SNOT-22 score. Poor asthma control could be detected using one or more sinus infections (70.6% sensitivity, 47.3% specificity), CRS-related antibiotics (50.0% sensitivity, 73.0% specificity), or CRS-related oral corticosteroids (58.8% sensitivity, 71.6% specificity) in the last 3 months. CONCLUSIONS AECRS are negatively associated with the level of asthma control in asthmatic CRS patients, independent of CRS symptom severity. These results highlight AECRS as a distinct clinical manifestation of CRS that should be routinely assessed in CRS patients. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:1033-1038, 2018.
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Affiliation(s)
- Raphael G Banoub
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Lloyd P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.,Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachussetts, U.S.A
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:218-236. [PMID: 28143692 DOI: 10.1016/j.jaip.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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A Systematic Review of the Treatment of Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia. SINUSITIS 2017. [DOI: 10.3390/sinusitis2010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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