Sino-Nasal 5 Questionnaire is Associated with Poor Asthma Control in Children with Asthma.

Sasikumar Kilaikode,Claudia Martinez,Dominique Prue,Gurpreet Phull,Krista Scheffey,Dinesh Pillai,Prateek Shukla,James Jackson

doi:10.3390/children4070054

Abstract

Up to 80% of asthmatic children may experience upper airway symptoms which are often perceived as coming from the lower airways. Currently, there are no validated questionnaires to assess upper airway contribution to pediatric asthma symptoms. The Sino-Nasal 5 (SN-5) questionnaire was previously validated for identifying radiographic confirmed sinus disease in children. In this study, we hypothesize that significant SN-5 scores (≥3.5) are associated with abnormal National Asthma Education and Prevention Program (NAEPP) based asthma impairment and control in asthmatic children. Retrospective data collected on children with asthma referred for pulmonary evaluation included age, gender, ethnicity, NAEPP asthma severity, asthma control (Test for Respiratory and Asthma Control in Kids (TRACK) < 5 years, Asthma Control Test (ACT) 5 years) and pulmonary function testing. Associations between SN-5 scores and asthma impairment and control were identified. Seventy-six children were evaluated; 38% were female with a mean age of 6.9 years. Significant SN-5 scores were associated with decreased control of daytime symptoms (odds ratio (OR): 0.16 (95% confidence interval (CI): 0.06–0.44)), night time awakenings (0.09 (0.03–0.29)), activity interference (0.2 (0.06–0.68)), NAEPP defined asthma control (0.32 (0.12–0.85)) and poor asthma control based on TRACK (p < 0.001) and ACT (p < 0.001). This suggests upper airways may play a larger role in perceived lower airway symptoms, and SN-5 may be beneficial in assessing the contribution of upper airway conditions on asthma control.

Highlights

Chronic rhinosinusitis (CRS) and asthma are two comorbid conditions that lead to pathologic clinical disease affecting the respiratory tract
Reviewing comorbidities associated with asthma, we identified significant association between Sino-Nasal 5 (SN-5) scoring and allergic rhinitis with SN-5 scores greater than or equal to 3.5 having a higher incidence (p = 0.01)
This study highlights the value of a screening tool for common comorbid conditions that affect perception of asthma control

Summary

Introduction

Chronic rhinosinusitis (CRS) and asthma are two comorbid conditions that lead to pathologic clinical disease affecting the respiratory tract. Up to 80% of children with asthma may experience upper airway symptoms, including rhinitis, which may be perceived as coming from the lower airway [1]. Medical management and control of perceived asthma symptoms by treating only the lower airway may be suboptimal. Rhinosinusitis affects the upper airways, the nose, nasal passages, and paranasal sinuses (frontal, sphenoid, ethmoid and maxillary). Asthma affects the intra-thoracic lower airways, which include the bronchi and bronchioles. The airway proves to be one contiguous structure, functionally working as a continuum between extra and Children 2017, 4, 54; doi:10.3390/children4070054 www.mdpi.com/journal/children

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