Prevalance of upper airway symptoms and aspects on treatment of nasal polyposis

Abstract

Background: Non-allergic rhinitis is a disease that is often trivialised, leading to inadequate management and unnecessary costs. One of the most common types of severe non-allergic nasal inflammation is nasal polyposis. Nasal polyposis is associated with asthma. The aims of this thesis were to estimate the prevalence of self-reported non-allergic nasal symptoms and explore relations of these symptoms to age and sense of smell (I), to study the effects of functional endoscopic sinus surgery (FESS) and fluticasone propionate nasal drops (FPND) 400 μg twice daily on lower airway and nasal parameters in patients with nasal polyposis and asthma (IV), to investigate the health impact of nasal polyposis with asthma and to study effects of FESS, as well as addition of FPND, on health related quality of life (HRQoL) in this patient group (V), to study the efficacy of mometasone furoate nasal spray (MFNS) 200 μg once daily in reducing relapse of nasal polyps in subjects with nasal polyposis who underwent FESS (II) and, to study the effect of FESS on sense of smell and olfactory thresholds in patients with nasal polyposis (III).

Methods: A questionnaire to a random sample of 15,000 individuals, 19-80 years (I). A randomised, double-blind, placebo-controlled study. 68 patients, >18 years, with nasal polyposis and asthma were randomised to FPND or placebo for 4 weeks prior to, and 5 weeks after FESS. For an additional 7 weeks all patients received FPND. Assessments pre- and post-FESS included; asthma symptoms, PEFR, FEV1, nasal symptoms, PNIF, olfactory thresholds, SF-36 (IV and V). A randomised, doubleblind, placebo-controlled, multi-centre study. 162 patients, >18 years, with nasal polyposis were randomised to MFNS or placebo approximately 2 weeks after FESS until relapse of nasal polyps or for a maximum of 6 months. Nasal polyps were scored on a 4-point scale for each nasal cavity (II). A study of 160 patients who had undergone FESS. Olfactory thresholds and sense of smell were measured pre-FESS and 2 weeks after surgery (III).

Results: The prevalence of self-reported non-allergic nasal symptoms was 19.3 % (95% CI 18.4-20.2) and did not change with age. In that group the prevalence of reduced sense of smell was 25.6% (95% CI 23.3-28.0) (I). Asthma symptoms decreased after FESS in both FPND and placebo groups 5 weeks after FESS (p=0.007), and PEFR was increased in the placebo group (p=0.010). All nasal symptoms decreased and PNIF and olfactory thresholds improved in both groups after FESS (p=0.015 0.001). There were no significant differences between the two groups (IV). At baseline HRQoL was decreased in both Physical Component Summary, PCS, (p=0.049) and Mental Component Summary, MCS, (p<0.001), as well as in 6 out of 8 domains compared with the reference population. FESS improved PCS (p=0.027) and MCS (p=0.021) as well as 5 out of 8 SF-36 domains after 5 weeks. We found additional benefit of FPND on 3 domains (V). Time to relapse was >175 days in the MFNS group and 125 days in the placebo group (ITT, p=0.049) (II). Olfactory threshold increased from 0 pre-FESS to 3.0 (p<0.001) 2 weeks post-FESS. Sense of smell score decreased from 3.0 pre FESS to 1.7 (p<0.001) post-FESS, i.e. improvement (III).

Conclusions: Self-reported non-allergic rhinitis symptoms are highly prevalent independent of age, and reduced sense of smell is a common complaint (I). FESS, but not addition of FPND, improved asthma symptoms as well as olfaction and PEFR in patients with nasal polyposis and asthma (IV). HRQoL is impaired in patients with nasal polyposis and concomitant asthma. FESS seems to have benefits on HRQoL in these patients and FPND can be added to improve, and also to reach population levels of, HRQoL at 5 weeks post-FESS (V). Post-FESS use of MFNS 200μg once daily increases time to relapse of polyps in patients with nasal polyposis (II). There are indications of a positive effect of FESS on olfaction in nasal polyposis (III).