PURPOSE: To evaluate the relationship between nasal symptoms with a specific nasal biomarker.
METHODS: Retrospective study of patients referred for exhaled nitric oxide (NO) determination in pulmonary clinic. The SinoNasal Outcome test (SNOT-20) questionnaire with 6 additional questions for sinusitis (SNOT20+6) was routinely administered. In addition, nasal NO levels at baseline (bNO) and while humming (hNO) were also obtained in the same sitting. Hierarchical cluster analysis (HCA) was used to place the SNOT-20+6 items into clusters. Association among patient characteristics, individual SNOT-20+6 items, the total score, the cluster scores and nNO levels at baseline, humming and humming/baseline ratio (hNO/bNO) were analyzed using Wilcoxon rank sum tests and Spearman rank correlation coefficients.
RESULTS: The SNOT-20+6 items resolve into five clusters. The cluster 2 items (post-nasal discharge, thick nasal discharge and decreased sense of smell) were negatively correlated with all nNO measurements. Ear fullness in Cluster 4 was negatively correlated with hNO and hNO/bNO. Finally, the total SNOT-20+6 score was found to negatively correlate with hNO and hNO/bNO with a p < 0.05.
CONCLUSION: A point-of-care clinical biomarker is potentially useful if it correlates with specific symptoms. Post-nasal discharge, thick nasal discharge and decreased sense of smell correlated inversely with the nNO measurements while ear fullness only with hNO and hNO/bNO. These data indicates that cluster 2 score and 4 may be the most useful tool for screening for sinonasal diseases in patients referred to pulmonary clinic for evaluation.
CLINICAL IMPLICATIONS: In Pulmonary practice, rhinitis and rhinosinusitis are frequent co-morbidities is patients presenting with asthma, chronic cough and other airway diseases. Simplification of the SNOT-20+6 questionnaire to the 11 symptoms may facilitate identification of patients with sinonasal problems. Symptoms plus biomarker at the point of care have the potential to be useful diagnostic tool.
DISCLOSURE: Eva Carmona, No Financial Disclosure Information; No Product/Research Disclosure Information