Paranasal sinus disease and sputum eosinophilia in prednisone-dependent asthma.
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OBJECTIVES: to investigate the extent and characteristics of paranasal sinus abnormalities (anatomic and mucosal) on computed tomographic (CT) sinus scans and to determine whether there is a relationship between these findings and eosinophilic airway inflammation in patients with prednisone-dependent asthma. METHODS: we conducted an observational survey of 15 prednisone-dependent asthmatic patients with respect to measures of airway inflammation and CT sinus scans. The pathologic changes on the CT scans were scored using the Lund-Mackay and JAMA staging systems, and several paranasal bony anatomic variations were recorded. Correlations between CT sinus measures and sputum eosinophil count as well as prednisone dose requirement to control sputum eosinophilia were examined. RESULTS: the JAMA and Lund-Mackay staging systems showed that greater sphenoidal mucosal disease was associated with increased prednisone dose requirements (OR 1.7, p = .05; OR 1.6, p = .021). Generally, both staging systems showed that specific sinus site involvement correlated with higher levels of sputum eosinophils. Mucosal thickening in the sphenoid sinus correlated most closely with sputum eosinophilia, followed by the maxillary and ethmoid sinuses and osteomeatal complex. Finally, there appeared to be a limited role for sinus anatomy as a predictive factor for the dose of prednisone required to control sputum eosinophilia. CONCLUSIONS: sinomucosal thickening, but not sinus anatomy, appears to be an important predictor of prednisone requirement and severity of eosinophilic bronchitis in severe asthma.
