Asia Pac Allergy.  2017 Oct;7(4):199-205. 10.5415/apallergy.2017.7.4.199.

Frequency and effect of type 1 hypersensitivity in patients from India with chronic obstructive pulmonary disease and associated upper airways symptoms

• Kumar A
• Kunal S
• Shah A

• KMID: 2410213
• DOI: http://doi.org/10.5415/apallergy.2017.7.4.199

Abstract

BACKGROUND
Chronic obstructive pulmonary disease (COPD) is now recognized as a systemic disorder with many comorbidities. Atopy in patients with COPD and upper airways symptoms has not been characterized.
OBJECTIVE
We investigated the occurrence and impact of aeroallergen sensitisation in patients with COPD and upper airways symptoms.
METHODS
All 41 subjects with COPD diagnosed as per Global Initiative for Chronic Obstructive Lung Disease guidelines, underwent spirometry with reversibility, computed tomography of the paranasal sinuses (CT-PNS), skin prick test (SPT) against common aeroallergens and responded to St. George's Respiratory Questionnaire (SGRQ) and Sino Nasal Outcome Test - 22 (SNOT-22) questionnaires. Upper airways symptoms were assessed as per the Allergic Rhinitis and its Impact on Asthma guidelines.
RESULTS
As documented earlier, 27 of the 41 patients (65.9%) with COPD had upper airways symptoms. Of these 27 patients, 11 had SPT positivity against at least one aeroallergen (group 1). One patient had monosensitisation to pollens of grass Imperata while polysensitisation was seen in 10/11 patients commonly to weeds, trees, and insects. Fungal sensitisation to Aspergillus fumigatus was seen in 3 of 11 patients (27.2%). In group 1, all 11 patients (100%) had radiological sinusitis as compared to 8 of 16 (50%) in group 2. The mean CT-PNS scores were significantly higher in group 1 as compared to group 2. Similarly, the SNOT-22 scores were significantly higher in group 1 as compared to group 2. However, there was no difference in SGRQ scores between the 2 groups. In group 1, there was a significant correlation between CT-PNS and SNOT-22 scores.
CONCLUSION
Patients with COPD, associated upper airways symptoms and a positive SPT had a significantly higher frequency of radiological sinusitis on CT-PNS. They even had worse quality of life as compared to those with a negative SPT. The study suggested that atopic patients with COPD and upper airways involvement were more symptomatic. It is therefore possible that upper airways symptoms, if left untreated, would result in less than desirable control of the disease.

Keyword

Allergic sensitization; Pulmonary disease, chronic obstructive; Quality of life; Skin prick test; Upper airways symptoms

MeSH Terms

Aspergillus fumigatus
Asthma
Comorbidity
Humans
Hypersensitivity*
India*
Insects
Paranasal Sinuses
Poaceae
Pollen
Pulmonary Disease, Chronic Obstructive*
Quality of Life
Rhinitis, Allergic
Sinusitis
Skin
Spirometry
Trees

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