title: Upper and lower airways associations in patients with chronic rhinosinusitis and bronchiectasis.
abstract: BACKGROUND
  Bronchiectasis is an uncommon disease of the lower airways characterized by bronchial wall destruction and permanent bronchiolar dilation. Several etiologic categories exist, and patients with bronchiectasis often complain of symptoms suggestive of chronic rhinosinusitis (CRS). The present study investigates the association between bronchiectasis and CRS using radiologic and bacteriologic data.
  
  
  METHODS
  Retrospective chart review from a tertiary care respiratory hospital was performed. Sinus computed tomography (CT) scans were examined for extent of disease and relationship to pulmonary disease severity. Statistical analysis was performed with Student t test and linear regression. Upper and lower airway cultures from patients with both bronchiectasis and CRS were compared using the chance adjusted agreement.
  
  
  RESULTS
  Patients with bronchiectasis were found to have a significantly higher Lund-Mackay score when compared to patients with allergic rhinitis (p = 0.047). Lund-Mackay CT score did not correlate with forced expiratory volume in 1 second (FEV1 ) and FEV1 :forced vital capacity (FVC), or presence of Pseudomonas aeruginosa. Correlation of upper and lower airway bacterial cultures in patients with both bronchiectasis and CRS was noted (kappa = 0.294, p = 0.004), particularly when P. aeruginosa was present (kappa = 0.49, p < 0.0001).
  
  
  CONCLUSIONS
  The current study suggests that the upper and lower airways may be linked in CRS and bronchiectasis from both an objective radiologic standpoint and a bacteriologic perspective. This finding carries implications for disease pathogenesis, clinical care, and future research.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO.
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ferril
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
authors.forename: Trudi
authors.initials: T
authors.lastname: Woodson
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Green
authors.forename: Todd T
authors.initials: TT
authors.lastname: Kingdom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology; D002908:Chronic Disease; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012137:Respiratory System / Q000000981:diagnostic imaging / Q000382:microbiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology; D013183:Sputum / Q000382:microbiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014797:Vital Capacity; D055815:Young Adult
keywords: bacteria; bronchiectasis; chronic rhinosinusitis; sinusitis; unified airway