Allergic Rhinitis Amplifies Asthma Risk in Patients With Chronic Rhinosinusitis: A Large-Scale Retrospective Cohort Analysis

IF 4.9 2区医学 Q1 OTORHINOLARYNGOLOGY

International Forum of Allergy & Rhinology Pub Date : 2026-09-04 Epub Date: 2026-03-13 DOI:10.1002/alr.70141

Austin J. Lee, Mohamad R. Chaaban

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引用次数: 0

Abstract

Background

Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two highly prevalent airway diseases in the United States. While the coexistence of CRS and asthma is well recognized, less is known about the development of new-onset asthma in CRS, particularly in the context of comorbid AR. This study assessed the impact of CRS and AR on incident asthma using a large electronic health record (EHR) database.

Methods

We conducted a retrospective cohort study using the TriNetX US Collaborative Network, a federated EHR platform encompassing over 100 million patients. Adults ≥ 18 years between January 2009 and December 2019 with CRS were compared to controls without CRS. A second analysis compared patients with CRS and concurrent AR to those with CRS alone. Supplemental analyses substituted chronic rhinosinusitis with nasal polyps (CRSwNP) for CRS. Propensity score matching balanced cohorts on demographics and comorbidities. Primary outcomes were new-onset asthma and asthma exacerbations, assessed at 1, 2, and 5 years.

Results

After matching, pre-existing CRS was associated with higher risk of new-onset asthma (adjusted relative risk [aRR] = 1.42, 95% CI 1.36–1.48) and exacerbations (aRR = 1.87, 95% CI 1.75–2.00) at 1 year versus CRS controls, with similar trends at 2 and 5 years. Coexisting AR further amplified risk: patients with CRS + AR had increased asthma incidence relative to CRS alone at 1 year (aRR = 1.69, 95% CI 1.65–1.73), 2 years (aRR = 1.65, 95% CI 1.62–1.68), and 5 years (aRR = 1.58, 95% CI 1.56–1.60), with more than doubled exacerbation risk across all time points. Directionally similar findings were observed in CRSwNP analyses.

Conclusions

CRS is associated with increased risk of incident asthma and subsequent exacerbations, and coexisting AR identifies a higher-risk phenotype within CRS. These findings highlight the need for phenotype-informed studies to determine whether targeted upper-airway management can mitigate downstream asthma burden.

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变应性鼻炎增加慢性鼻窦炎患者哮喘风险：一项大规模回顾性队列分析

背景：慢性鼻窦炎（CRS）和变应性鼻炎（AR）是美国两种高度流行的气道疾病。虽然CRS和哮喘的共存是公认的，但对CRS中新发哮喘的发展知之甚少，特别是在合并性AR的背景下。本研究使用大型电子健康记录（EHR）数据库评估了CRS和AR对哮喘事件的影响。方法：我们使用TriNetX美国协作网络（一个包含超过1亿患者的联邦电子病历平台）进行了一项回顾性队列研究。2009年1月至2019年12月期间患有CRS的≥18岁成年人与没有CRS的对照组进行比较。第二项分析比较了CRS合并AR患者与单独CRS患者。补充分析用慢性鼻窦炎伴鼻息肉（CRSwNP）代替CRS。倾向评分匹配人口统计学和合并症的平衡队列。主要结局为新发哮喘和哮喘加重，分别在1年、2年和5年进行评估。结果：匹配后，与CRS对照组相比，已存在的CRS与1年新发哮喘（校正相对危险度[aRR] = 1.42, 95% CI 1.36-1.48）和加重（aRR = 1.87, 95% CI 1.75-2.00）的风险较高相关，2年和5年的趋势相似。共存的AR进一步放大了风险：与单独的CRS相比，CRS + AR患者在1年（aRR = 1.69, 95% CI 1.65-1.73）、2年（aRR = 1.65, 95% CI 1.62-1.68）和5年（aRR = 1.58, 95% CI 1.56-1.60）时哮喘发病率增加，所有时间点的恶化风险都增加了一倍以上。在CRSwNP分析中也观察到方向性相似的结果。结论：CRS与哮喘发作和随后的加重风险增加有关，共存的AR在CRS中是一种高风险表型。这些发现强调了表型研究的必要性，以确定靶向上呼吸道管理是否可以减轻下游哮喘负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Forum of Allergy & Rhinology OTORHINOLARYNGOLOGY-

CiteScore

11.70

自引率

10.90%

发文量

185

审稿时长

6-12 weeks

期刊介绍： International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.