Chronic rhinosinusitis with nasal polyps shows an independent link to type 2 inflammation markers among individuals suffering from bronchiectasis, as revealed by a large-scale European registry study featured in ERJ Open Research. Researchers evaluated 16,640 adults enrolled in the European Multicentre Bronchiectasis Audit and Research Collaboration registry to determine how sinonasal disease, bronchiectasis aetiology, and type 2 inflammatory markers intersect across diverse patient populations.
Prevalence of Sinonasal Disease Across Bronchiectasis Aetiologies
Chronic rhinosinusitis affects 32% to 75% of people with bronchiectasis. This prevalence is significantly higher than the estimated 5% to 10% prevalence found in the general population. Data from the European Multicentre Bronchiectasis Audit and Research Collaboration registry show that sinonasal disease rates vary substantially depending on the underlying cause of bronchiectasis. Investigators noted particularly high rates among patients with primary ciliary dyskinesia, asthma, immunodeficiency, and allergic bronchopulmonary aspergillosis.
Respiratory Symptoms and Hospitalisation Risks
Patients with bronchiectasis and coexisting chronic rhinosinusitis experience distinct clinical challenges compared to those without sinonasal disease. According to the registry analysis, both chronic rhinosinusitis groups exhibited greater sputum production and purulence. Chronic bacterial infection was also more prevalent in these cohorts. After adjusting for clinical confounders, researchers found that these patients reported worse respiratory symptom scores.
Baseline comparisons initially suggested more frequent exacerbations in patients with chronic rhinosinusitis. However, this association did not persist after multivariable adjustment. Researchers noted that the presence of chronic rhinosinusitis, whether accompanied by nasal polyps or not, displayed an independent correlation with a reduced likelihood of hospital admissions related to bronchiectasis. Mortality was also lower among those without nasal polyps after full adjustment. For patients with chronic rhinosinusitis and nasal polyps, the point estimate favoured lower mortality, although the 95% confidence interval included no difference.
Type 2 Inflammation Biomarkers in Registry Data
Previous studies linked coexisting chronic rhinosinusitis with elevated blood eosinophils and immunoglobulin E. The European Multicentre Bronchiectasis Audit and Research Collaboration registry analysis sought to clarify whether this type 2 inflammatory profile extends across different aetiologies. For patients suffering from idiopathic bronchiectasis as well as post-infectious bronchiectasis, the presence of chronic rhinosinusitis—with or without nasal polyps—corresponded to an increased frequency of elevated blood eosinophils. This specific pattern did not appear in bronchiectasis associated with primary ciliary dyskinesia or immune deficiency.
When researchers considered multiple clinical and aetiological factors together, chronic rhinosinusitis with nasal polyps remained independently associated with elevated type 2 biomarkers. Asthma, chronic obstructive pulmonary disease, and allergic bronchopulmonary aspergillosis also showed independent associations with these biomarkers. Patients without nasal polyps did not retain this independent association.
Did You Know? The study authors acknowledged limitations in their work, including reliance on investigator-recorded diagnoses of chronic rhinosinusitis rather than validation against established diagnostic criteria. Furthermore, blood eosinophil and total immunoglobulin E measurements were unavailable for a portion of the cohort.
Future Directions for Type 2-Directed Treatments
The study authors concluded that clinical features help identify selected patients in whom type 2 inflammation warrants further investigation.
Frequently Asked Questions
What is the prevalence of chronic rhinosinusitis in people with bronchiectasis?
Chronic rhinosinusitis is reported in 32% to 75% of people with bronchiectasis, compared to 5% to 10% in the general population.
How does bronchiectasis aetiology affect sinonasal disease rates?
The prevalence of sinonasal disease varies substantially by aetiology and is particularly high in patients with primary ciliary dyskinesia, asthma, immunodeficiency, and allergic bronchopulmonary aspergillosis.
Are nasal polyps linked to elevated type 2 biomarkers?
Yes. Chronic rhinosinusitis with nasal polyps remains independently associated with elevated type 2 biomarkers, alongside conditions like asthma, chronic obstructive pulmonary disease, and allergic bronchopulmonary aspergillosis.
What database was used for this European analysis?
The study analysed 16,640 adults enrolled in the prospective European Multicentre Bronchiectasis Audit and Research Collaboration registry.
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