title: Characterization and treatment of patients with chronic rhinosinusitis and nasal polyps.
abstract: BACKGROUND
  Patients with chronic rhinosinusitis (CRS) and nasal polyps (NPs) may be subdivided into aspirin-sensitive (AS) and aspirin-tolerant (AT) populations. These cohorts are not well characterized.
  
  
  OBJECTIVE
  To examine phenotypic characteristics and determine the extent of medical/surgical interventions in patients with CRS+NP and to compare the AS with the AT subset in the CRS+NP sample.
  
  
  METHODS
  Retrospective chart review was performed at a tertiary academic respiratory hospital. Data included patient demographics, asthma severity, peripheral eosinophilia, Lund-Mackay computed tomographic score, symptomatic dysosmia, and therapeutic interventions.
  
  
  RESULTS
  Of the 182 patients included, 81 had aspirin sensitivity (45%) and 101 had aspirin tolerance (55%). Asthma was present in 94% of patients with CRS+NP (100% in AS subgroup vs 89% in AT subgroup, P = .001). Eighty-eight percent of the CRS+NP sample had moderate to severe persistent asthma. In the AS and AT subgroups, asthma severity was similar (P > .6). The CRS+NP sample showed a mean computed tomographic score of 14.0 (44% with eosinophilia and 46% with dysosmia). More severe sinus disease was noted in the AS group (Lund-Mackay computed tomographic scores, P = .002; olfactory symptoms, P = .001). Serum eosinophil levels were not statistically different between groups (51% in AS group, 39% in AT group, P > .1).
  
  
  CONCLUSIONS
  This study is one of the broadest reviews of patients with CRS+NP, with unique findings in the high prevalence of asthma in AS and AT patients, greater olfactory dysfunction in AS patients, and a minority of patients with CRS+NP and circulating eosinophils. Most AS patients do not have increased circulating eosinophils, as is often believed. These results shed further light on the association between asthma and upper respiratory tract disease in those with nasal polyposis.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Fountain
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Mudd
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Sillau
authors.forename: Todd T
authors.initials: TT
authors.lastname: Kingdom
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Katial
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D004351:Drug Resistance; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D000857:Olfaction Disorders; D010256:Paranasal Sinuses / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D001241:Aspirin