Chronic rhinosinusitis control from the patient and physician perspectives

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.