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Table 8. Modifying Factors for Adult Sinusitis
Question Answer
Asthma Screen for asthma.
CRS control including endoscopic sinus surgery may help
asthma-related symptoms.
Cystic fibrosis Cystic fibrosis transmembrane conductance regulator (CFTR)
modulators have significant impact on CRS treatment and
outcomes.
Ciliary dyskinesia Need for high index of suspicion in patient with recurrent
pulmonary infections (rare).
Confirmatory diagnosis for primary ciliary dyskinesia (PCD)
with history, genetic testing, and/or electron microscopy.
Immunosuppressive
state
Patients with RARS or CRS symptoms and other infectious
conditions such as pneumonia, bronchitis, gastroenteritis.
Consider treatment with prophylactic antibiotics and
vaccination. Consult with allerg y/immunolog y regarding the
use of immunoglobulin replacement therapy.
Aspirin exacerbated
respiratory disease
(AERD)
Need for high index of suspicion in patients with severe asthma,
early recurrence of disease.
Confirmation of diagnosis with strong clinical history of aspirin
intolerance and/or aspirin challenge.
Other conditions:
Gastroesophageal
reflux disease
(GERD)/
laryngopharyngeal
reflux (LPR)
ere is an association between CRS and GERD.
Proton pump inhibitor (PPI) therapy may improve nasal
symptoms and endoscopy, but limited evidence in mild or
subclinical disease.
Smoking Smoking increases prevalence of CRS.
Bronchiectasis Greater than 50% of patients with bronchiectasis have CRS.
is is associated with poorer quality of life (QOL) and greater
disease severity.
Depression/anxiety Common in CRS patients.
May limit the improvement in QOL scores aer treatment.
Sleep Rhinologic conditions may lead to mild obstructive symptoms
and subjective poor sleep quality.
