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The Impact of Bronchiectasis Associated to Sinonasal Disease on Quality of Life

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The Impact of Bronchiectasis Associated to Sinonasal Disease on Quality of Life View metadata, citation and similar papers at core.ac.uk ARTICLE IN PRESS brought to you by CORE provided by Elsevier - Publisher Connector Respiratory Medicine (2006) 100, 1997–2003 The impact of bronchiectasis associated to sinonasal disease on quality of life J.M. Guilemanya,Ã, I. Alobida,b, J. Angrillc, F. Ballesterosa, M. Bernal-Sprekelsena, C. Picadoc, J. Mullola,d aRhinology Unit, Department of Otorhinolaryngology, Hospital Clinic de Barcelona, ENT, Barcelona, Spain bDepartment of Otorhinolaryngology, Hospital Municipal de Badalona, Badalona, Spain cDepartment of Pneumology, Hospital Clı´nic, Department of Medicine, University of Barcelona, Spain dInstitut d’Investigacions Biome`diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Received 20 September 2005; accepted 19 February 2006 KEYWORDS Summary Bronchiectasis; Background: Bronchiectasis (BQs) is an uncommon disease with the potential to Nasal polyposis; cause devastating complications. All patients with BQs have cough and chronic Quality of life; sputum production that may have a great impact on patient’s quality of life. Upper SF-36 questionnaire airway symptoms are also frequent in patients with BQs. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis and asthma, chronic obstructive lung disease and chronic rhinosinusitis. Objective: (1) To investigate the impact of bronchiectasis and nasal symptoms on quality of life. (2) To evaluate the added impact of nasal polyposis on quality of life in patients with BQs. Methods: Sixty patients with bronchiectasis and upper airway symptoms were included. Patients were evaluated for nasal symptoms, nasal polyp size by endoscopy, and quality of life using the SF-36 generic questionnaire. Results: In comparison with the Spanish general population, patients with BQs had worse scores in all SF-36 domains (Po0.05). Males reported significantly higher quality of life scores on physical functioning and social functioning than females did. Although the age, pulmonary function, presence of nasal polyps, upper airway symptoms, tobacco smoking history, and disease duration was similar between them. Males with BQs had worse quality of life than males from the Spanish general population on body pain, general health, and vitality (Po0.05). Females with BQs had worse quality of life than females from the Spanish general population on physical function, body pain, general health, vitality, social function, and emotional role (Po0.05). Nasal polyps were found in 25 (41.6%) of 60 patients with BQs. ÃCorresponding author. Tel.: +34 932 279 872; fax: +34 932 275 454. E-mail address: [email protected] (J.M. Guilemany). 0954-6111/$ - see front matter & 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.rmed.2006.02.016 ARTICLE IN PRESS 1998 J.M. Guilemany et al. No significant differences were observed on quality of life outcomes between patients with BQs with and without nasal polyposis. Conclusion: These results suggest that BQs has a considerable impact on quality of life while nasal polyposis has no additional impact on the quality of life of patients with BQs. & 2006 Elsevier Ltd. All rights reserved. Introduction thereby making it possible to assess the burden of illness in different conditions. The Short Form-36 Bronchiectasis (BQs) consists of a permanent and Health Survey (SF-36) is the most widely used irreversible destruction and dilatation of bronchi generic instrument to measure health status. This and bronchioles due to retained secretions and questionnaire has been recently adapted for the recurrent infections that cause inflammation, ob- Spanish-speaking general population according to struction, and damage of the lower airway. BQs are the International Quality of Life Assessment (IQO- a consequence of a variety of different diseases LA) project showing a good reproducibility and 8–10 where infection and obstruction appears to be the validity. most important contributory factors. BQs are The aims of this study were: (1) to investigate frequently associated with cystic fibrosis, primary the impact of BQs and nasal symptoms on QoL ciliary dyskinesia, immunodeficiency, rheumatoid compared with the Spanish general population arthritis, and inflammatory bowel disease.1 using the SF-36 questionnaire; and (2) to evaluate Nasal polyposis (NP) is a chronic inflammatory the additional impact of mild-moderate nasal disease of the nose and sinus mucosa that, despite polyposis on QoL in patients with BQs. differing hypotheses of its cause, remains poorly understood.2,3 NP can lead to progressive nasal Material and methods obstruction, loss of smell, rhinorrhea, and sneez- ing. NP is frequently associated with asthma and Study population: sixty patients with non-cystic other pulmonary disorders such as cystic fibrosis, fibrosis BQs in a stable phase of their illnes with primary ciliary dyskinesia, and aspirin sensitivity.4,5 upper airways symptoms were included in this BQs is a disease with the potential to cause prospective study from April 2002 to July 2004. devastating complications. The patients with BQs Design: the diagnosis of BQs was based on have cough and chronic sputum production that symptoms, physical findings, and thoracic high- have a great impact on patient’s quality of life resolution CT scan. Stability of the BQs condition (QoL). Most patients undergo slow and progressive was assessed with a complete clinical evaluation, a health deterioration over decades. It can have forced spirometry, and if is necessary a thorax detrimental effects on physical, psychological, and radiology. Stable BQs condition was defined as the social aspects of the patient0s life, significantly absence of fever, no impairment of airflow limita- worsening the patient’s QoL. The lung function tion, no increase in sputum overproduction or does not reflect the impact of the disease in the change of the macroscopic characteristics (puru- patient0s health status and thus should be supple- lent), and no increase in chronic cough. In mented using QoL questionnaires.6 However, the summary, no increase in respiratory symptoms or impact of BQs to patients’ general health status has modifications in the treatment over the previous 6 not been reported for the Spanish patients. Gen- weeks. The day of the study, a complete clinical erally, there are two major types of QoL instru- evaluation and a forced spirometry (Collins Survey ments used in clinical trials: specific and generic. III, plus, USA) were performed. Exclusion criteria Specific questionnaires are usually focused on one were hospitalization in the previous 2 months, use particular area such as a disease state, a selected of antibiotics in the last 4 weeks or presence of a population, or a certain function or problem. The serious concomitant illness. St. George Respiratory Questionnaire (SGRQ) has The diagnosis of nasal polyposis was based on the been used to assess the QoL in patients with visualization of bilateral polyps under nasal endo- asthma, COPD, a1-antitrypsin deficiency, intersti- scopic examination. Approval for the study was cial lung diseases and BQ.7 obtained from the Ethic’s Committee of our Generic QoL questionnaires are also available institution and a signed informed consent was and may be administrated to any individual, obtained from all patients. ARTICLE IN PRESS The impact of bronchiectasis 1999 After a 4-week washout period of oral and Statistical analysis: was performed using SPSS for intranasal steroids, all patients with BQs completed Windows (SPSS 11.0, Chicago, IL, USA). All analyses the SF-36 survey. Nasal symptoms and nasal were performed using two-tailed tests significance endoscopy were also scored. Most of experimental at the 0.05 level. The data are presented as studies and clinical trails investigating nasal poly- mean7SD (standard deviation). All data were posis consider adequate a washout period of 4 assesed for normal distribution and the Bonferroni weeks since patients with sinonasal pathology often correction for multiple comparisons was used. Our follow treatments with oral antihistamines, oral first objective was to investigate the impact of BQs and intranasal corticosteroids, oral antibiotics, and and nasal symptoms on QoL compared with the nasal lavages that may improve the clinical Spanish general population using the SF-36 ques- symptoms.11,12 tionnaire. A study population size of 29 patients per Quality of life: the Health Survey SF-36 consists group, achieves 95% power to detect a difference of 36 self-administered questions and was devel- of 20% between the null hypothesis mean of 82.7 oped to measure eight health domains: physical (PCS) and the alternative hypothesis mean of 66.4 functioning (PF), role physical (RP), bodily pain with an estimated standard deviation of 23.3 and (BP), general health (GH), vitality (VT), role with a significance level (alpha) of 0.05 using a two- emotional (RE), social functioning (SF), and mental sided one-sample t-test. health (MH). Two summary scales are also included: Unpaired Student’s t test was used to compare the physical component summary (PCS) and the nasal symptoms and SF-36 scores of patients with mental component summary (MCS). Spanish version BQs with those from the Spanish general popula- of the SF-36 Health Survey was used. This version is tion, and between patients with or without NP. SF- very similar to the original US questionnaire in 36 scores for healthy control subjects from the absolute values, age and gender. We needed a Spanish population used in comparative analyses generic questionnaire to assess QoL in pathology were derived from a sample of 9984 people of potentially involved both upper and lower airways: whom 51.8% were females. Males of the Spanish bronchiectasis and sinonasal pathology (with or general population have demonstrated significant without nasal polyposis). Scale scores in each higher scores than females in all SF-36 dimensions.7 domain and summaries range from 0 to 100, higher After analyzing matching for age, no significant scores indicating better QoL.13 difference on the mean age between patients of Nasal symptoms: obstruction, loss of the sense of our study and the Spanish general population.
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