Asthma and chronic rhinosinusitis are prevalent conditions, impacting millions of Americans. Moreover, almost one-third of patients with chronic rhinosinusitis also have asthma, and comorbidity may increase the disease burden of asthma and complicate its treatment. In addition, there is data that chronic rhinosinusitis is more severe among African American patients. Nevertheless, the full scope of asthma control in African American patients with asthma (with and without comorbid chronic rhinosinusitis) has not been fully elucidated.
At the 2024 American Rhinologic Society (ARS) meeting at the COSM, held on May 15–16, 2024 in Chicago, Evan Patel, MS from Rush University Medical Center presented data on differences in asthma control between patients with comorbid asthma and chronic rhinosinusitis versus patients with asthma only, stratified by race.
The investigators conducted a longitudinal, prospective study comparing the disease burden of patients with asthma and comorbid chronic rhinosinusitis versus patients with asthma alone at a tertiary care center. This study included 423 patients, of which 126 had asthma only and 297 had comorbid asthma and chronic rhinosinusitis. Among the study participants, 185 were African American and 238 were White. The number of asthma exacerbations, asthma-related hospitalizations, and asthma-related emergency department visits as well as Asthma Control Test (ACT) scores were recorded.
Patients with asthma only had significantly lower odds of asthma-related hospitalizations than patients with comorbid asthma and chronic rhinosinusitis (p = 0.001), after controlling for demographic characteristics, insurance status, and the presence of allergic rhinitis. In addition, the odds of having asthma that is not well controlled (ACT score £ 19) were significantly lower in patients with asthma only than in patients with comorbid asthma and chronic rhinosinusitis (p < 0.0001).
Among patients with asthma only, the odds of asthma-related emergency department visits were higher in African American patients than in White patients (p = 0.016). Moreover, among patients with comorbid asthma and chronic rhinosinusitis, the odds of asthma-related hospitalizations were higher among African American patients than among White patients (p = 0.032).
The study demonstrated a negative effect of chronic rhinosinusitis comorbidity on asthma control. These findings may be explained by the unified airway hypothesis. Even though chronic rhinosinusitis affects the upper airway and asthma the lower airway, the unified airway hypothesis connects the two conditions, as it postulates that there is one connected airway, and the same inflammatory pathways are implicated throughout it. Thus, chronic rhinosinusitis may contribute to the development of a more complex and severe unified airway disease, and unified airway disease management may help to enhance patient outcomes.
In addition, the findings of this study indicate that race impacts the outcomes of asthma and chronic rhinosinusitis, and there are racial disparities in patients with comorbid chronic rhinosinusitis and asthma. Evan Patel emphasized: “So far, robust data in the literature demonstrate that racial disparities are not caused by biological racial differences; rather, African Americans are consistently disadvantaged with worse outcomes compared to their White counterparts. It’s likely that structural racism plays a role in this hindrance towards equitable health outcomes, likely caused by the social determinants of health that are widely known in the literature.”
In conclusion, Evan Patel emphasized that clinicians should consider the presence of chronic rhinosinusitis when evaluating patients with asthma, and especially patients from minority populations. Moreover, designing tailored management strategies can help to improve the outcomes of asthma and chronic rhinosinusitis and to address the disparities observed among African American patients with these conditions. Thus, comprehensive management approaches and personalized therapeutic interventions are needed to optimize outcomes in patients with comorbid asthma and chronic rhinosinusitis.