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Original Research: ASTHMA |

Criteria To Screen for Chronic Sinonasal Disease

Anne E. Dixon, MD, FCCP; Elizabeth A. Sugar, PhD; S. James Zinreich, MD; Raymond G. Slavin, MD; Jonathan Corren, MD; Robert M. Naclerio, MD; Masaru Ishii, MD, PhD; Rubin I. Cohen, MD, FCCP; Ellen D. Brown, MS; Robert A. Wise, MD, FCCP; Charles G. Irvin, PhD; for the American Lung Association-Asthma Clinical Research Centers
Author and Funding Information

Affiliations: From the Department of Medicine (Drs. Dixon and Irvin), University of Vermont, Burlington, VT; Johns Hopkins University (Drs. Sugar, Zinreich, Ishii, and Wise, and Ms. Brown), Baltimore, MD; Saint Louis University (Dr. Slavin), St. Louis, MO; University of California Los Angeles (Dr. Corren), Los Angeles, CA; the Department of Surgery (Dr. Naclerio), University of Chicago, Chicago, IL; and the Department of Pulmonary and Sleep Medicine (Dr. Cohen), North Shore-Long Island Jewish Medical Center, New Hyde Park, NY.

Correspondence to: Anne E. Dixon, MD, FCCP, University of Vermont, Medicine, Patrick 204, 111 Colchester Ave, Burlington, VT 05401; e-mail: anne.dixon@uvm.edu

*A complete list of participants is located in the Appendix.


The preliminary results of phase 1 of this study were presented at the meeting of the American Thoracic Society in San Francisco, May 20, 2007.

Funding/Support: This study was supported by the American Lung Association, National Institutes of Health grant RR019965, and an unrestricted grant from Schering-Plough.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(5):1324-1332. doi:10.1378/chest.08-1983
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Background:  Sinusitis and rhinitis are associated with uncontrolled asthma. There are no simple, validated tools to screen for these diseases. The objective of this study was to assess instruments to assist in the diagnosis of chronic sinonasal disease.

Methods:  Participants without acute sinonasal symptoms underwent an extensive evaluation. The results were submitted to an expert panel that used the Delphi method to achieve consensus. Using the consensus diagnosis of the panel, we determined the sensitivity and specificity of test procedures to diagnose chronic sinonasal disease. We determined the reproducibility of the most sensitive and specific instrument in a separate cohort.

Results:  Fifty-nine participants were evaluated, and the expert panel reached consensus for all (42 participants with chronic sinonasal disease, 17 participants without chronic sinonasal disease). A six-item questionnaire based on the frequency of nasal symptoms was the most sensitive tool used to diagnose sinonasal disease (minimum specificity, 0.90). Reproducibility testing in a separate cohort of 63 participants (41 chronic sinonasal disease with asthma, 22 chronic sinonasal disease without asthma) showed a concordance correlation coefficient of 0.91 (95% CI, 0.85 to 0.94) when this questionnaire was limited to five items (ie, excluding a question on smell). This five-item questionnaire had a sensitivity of 0.90 (95% CI, 0.77 to 0.97), a specificity of 0.94 (95% CI, 0.71 to 1.00), and an area under the receiver operating characteristic curve of 0.97 (95% CI, 0.93 to 1.0). Sinus CT scans and nasal endoscopy lacked sensitivity for use in the diagnosis of chronic sinonasal disease.

Conclusions:  We have developed a sensitive, specific, and reproducible instrument to screen for chronic sinonasal disease. Validation studies of this five-item questionnaire are needed, including in patients with asthma.

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