Occurrence and Effects of Nasal Polyps in Patients with Bronchial Asthma and/or Allergic Rhinitis

Background: The occurrence of nasal polyps (NP) in bronchial asthma (BA) and/or allergic rhinitis (AR) remains largely undiagnosed and adversely affects quality of life (QoL).                                        

Methods: The study comprised 220 consecutive patients (males/females, 123/97), 15 to 60 years with BA and/or AR enrolled from outpatients department of VP Chest Institute, University of Delhi. BA/AR was diagnosed according to GINA/ARIA guidelines respectively. Group1 comprised 35 patients with BA, group2, 43 patients with AR and group3, 142 patients with both diseases. CT-PNS, done in all patients, assessed CRS/NP and was scored with Lund Mackey Score (LMS). To assess the effect of NP, asthmatics responded to asthma QoL questionnaire (MiniAQLQ), and the 15-17 years to MiniPAQLQ. Rhinitics responded to rhinoconjunctivitis QoL questionnaire (RQLQ) and the 15-17 years to AdolRQLQ. Patients with nasal symptoms responded to Sinonasal Outcome Test 22 (SNOT 22) and Visual Analogue Scale (VAS).

Results: Of the 220 patients, 190(86.4%) had CRS. Of these, 138(72.6%) had NP. CRS was seen in 26/35(74.3%) patients in group1, 38/43(88.4%), in group2 and 126/142(88.7%), in group3. NP was seen in 18/26(69.2%), 30/38(78.9%) and 90/126(71.4%) in groups 1, 2 and 3 respectively. The presence of NP increased mean LMS score from 5 in CRS to 8(P=0.005) in CRS/NP patients. In group2, occurrence of NP increased mean Global VAS score from 5 to 7(P=0.029), SNOT 22 scores from 43 to 44(P=0.029) and in RQLQ scores, activities score rose from 1.7 to 3.1(P=0.007), nasal symptom score from 3.9 to 4.1(P=0.033), non hayfever symptom score from 2.3 to 3.5(P=0.045) and RQLQ overall scores from 2.4 to 3.1(P=0.023). In group3, NP increased mean SNOT 22 scores from 39 to 42(P= 0.002), RQLQ nasal symptom score from 4.2 to 4.4(P=0.001) and RQLQ troubled sleep score from 1.7 to 1.9(P=0.021). There were no significant differences in group1. In all three groups, presence of NP increased mean RQLQ activities score from 3 to 3.3(P=0.033) and RQLQ troubled sleep score from 1.7 to 2(P=0.010).

Conclusions: NP was seen in nearly two-third (62.7%) of patients with BA and/or AR. QoL was maximally impaired when AR was complicated with NP followed by patients with both diseases.