Impact of Chronic Rhinosinusitis on Long-Term Clinical Outcomes in Adults With Asthma.

Abstract

Chronic rhinosinusitis (CRS) is a common comorbidity affecting clinical outcomes in adults with asthma. To assess the impact of CRS on long-term asthma outcomes in a real-world clinical setting. This retrospective cohort study analyzed the medical records of 16,153 adults with asthma at the Ajou University Medical Center, Korea. Patients were classified into those with and without comorbid CRS. The CRS group was further stratified into the type 2 (T2)-high and T2-low CRS subgroups based on blood eosinophil counts. Over a 10-year follow-up, long-term clinical outcomes, including asthma exacerbation (AE), hospitalization or emergency department (ED) visits, and systemic corticosteroid use, were estimated using Kaplan-Meier curves and Cox proportional hazards models. We analyzed longitudinal laboratory and lung function measures using adjusted linear mixed-effects models. After propensity score matching, we performed between-group comparisons. The CRS group had higher risks of severe AE (hazard ratio [HR] = 2.07; 95% CI, 1.51-2.87), overall AE (HR = 1.59; 95% CI, 1.36-1.86), hospitalization or ED visits (HR = 1.38; 95% CI, 1.08-1.78), and systemic corticosteroid use (HR = 1.44; 95% CI, 1.25-1.66). Further, these risks were persistently higher in the T2-high CRS subgroup than in the T2-low CRS subgroup (P < .001 for all). Throughout the follow-up, the CRS group, particularly the T2-high subgroup, exhibited elevated blood or sputum eosinophils and FeNO levels, with greater lung function decline than in the non-CRS or T2-low CRS subgroups. Comorbid CRS, particularly a T2-high CRS endotype, is associated with increased 10-year risk of AEs, hospitalizations or ED visits, and systemic corticosteroid use, as well as greater lung function decline in adults with asthma.