Mental, Physical QOL From CRSwNP Worse vs General Population

Worsened health-related quality of life (HRQOL) in terms of physical and mental health was seen among patients with severe cases of chronic rhinosinusitis with nasal polyps (CRSwNP), according to new data published in Journal of Asthma and Allergy.

Outcomes for these patients were compared with those seen among a general population using data from the SINUS-24 trial. Evaluations were conducted using the 36-item Short Form (SF-36) questionnaire and the EuroQol-5 Dimension visual analog scale (EQ VAS); the population norm scores used were 50 and 70.4 to 83.3, respectively.

Among the 276 patients included in the intention-to-treat analysis, analyses were conducted for overall outcomes and between patient subgroups: with/without prior nasal polyps (NP) surgery, previous systemic corticosteroid (SCS) use (within the last 2 years) and prior surgery or previous SCS use and no prior NP surgery, with/without coexisting asthma, with/without coexisting nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD), and with/without anosmia.

“CRSwNP is a predominantly type 2 inflammatory disease with a high symptom burden,” the study investigators wrote. “However, data are lacking on the comparative health status of patients with CRSwNP.”

Overall, 76% of patients had anosmia; 71.7%, history of sinonasal surgery; 58.3%, coexisting asthma; 38.4%, prior sinonasal surgery and SCS use; and 30.4%, coexisting NSAID-ERD. Their mean (SD) age was 50.5 (13.4) years, 42.8% were female patients, and mean years since NP diagnosis was 11.1 (9.2) years.

The scores for the mental component summary (MCS) and physical component summary (PCS) of the SF-36 were 46.4 and 48.6, respectively, which were lower than the population norm of 50. Mean EQ-VAS score was also lower than the published norm range of 70.4 to 83.3, coming in at 66.0.

Comparisons were also made between the population of patients with CRSwNP and individuals living with rheumatoid arthritis, type 2 diabetes (T2D), and asthma. Scores were similar overall for T2D and asthma, but for rheumatoid arthritis, the result was a low 32.5.

For analyses specifically carried out among patient subgroups, the following results were seen:

• Among the patients with CRSwNP and comorbid asthma (n = 161), lower scores of 44.5 and 48.1 were seen for the SF-36 PCS and MCS, respectively,and this group’s mean EQ-VAS was 64.8, all lower vs population norms
• Among those with NSAID-ERD (n = 84), scores were lower for SF-36 PCS, SF-36 MCS, and EQ-VAS compared with the participants who had comorbid asthma: 44.4, 48.1, and 63.9, respectively—all again lower than the population norms
• Among the individuals who had anosmia (n = 208), similar scores were seen for PCS, MCS, and EQ-VAS as among those with comorbid asthma: 45.4, 48.3, and 63.9, which are still below population norms

In addition, the SF-36 PCS and MCS had moderate and weak correlations, respectively, with the EQ-VAS score; SF-36 scores overall had weak correlations with nasal polyp score, Lund-Mackay CT, and University of Pennsylvania Smell Identification Test, all objective measures of disease severity; and 22-item Sino-Nasal Outcome Test total score had moderate correlations with both SF-36 PCS and MCS.

Speaking to the importance of their findings, the study authors underscored that their data add to previous studies’ results on impaired physical and mental HRQOL and that the findings may be more generalizable because of the global study population they included.

This decreased HRQOL “may result from the myriad of symptoms associated with severe disease and its common comorbidities as well as from under-recognized humanistic and economic impacts of living with such disease on a daily basis,” they concluded.

Because of this, they emphasize the importance of analyzing HRQOL separately because clinical measures are unable to do so.

Reference

Maspero JF, Khan AH, Philpott C, et al. Health-related quality of life impairment among patients with severe chronic rhinosinusitis with nasal polyps in the SINUS-24 trial. J Asthma Allergy. 2023;16:323-332. doi:10.2147/JAA.S372598