Impact of chronic rhinosinusitis on health-related quality of life

Kronični rinosinuitis (KRS) je definiran kao upala sluznice nosa i paranazalnih sinusa koja unatoč brojnim istraživanjima i hipotezama ostaje uglavnom nerazjašnjena. KRS postoji u dva klinička fenotipa kao KRS sa ili bez nosnih polipa koji se razlikuju prvenstveno u endoskopskom nalazu (bez kortikosteroidne terapije). KRS je izuzetno česta bolest s prevalencijom od 5-15 % europske i američke populacije. Glavni simptomi su začepljenost nosa, nosni iscjedak, bolnost/pritisak lica u projekciji sinusa te gubitak njuha. Predisponirajući faktori za razvoj KRS-a su oštećenja cilijarne funkcije, alergije, astma, imunodeficijentna stanja, lokalni faktori domaćina, mikroorganizmi i aspirinska preosjetljivost. Dijagnoza KRS-a postavlja se procjenom simptoma rinosinuitisa te endoskopskim i slikovnim metodama. KRS ima značajan negativan utjecaj na kvalitetu života oboljelih osoba. Kvaliteta života je pojam koji obuhvaća funkcionalne posljedice bolesti i liječenja percipirane od strane pacijenata i nužno ju je mjeriti na valjan način. Glavni instrumenti za procjenu kvalitete života su upitnici za procjenu općeg i za bolest specifičnog stanja. Pri odabiru odgovarajućeg upitnika vrlo je važan odnos obilježja upitnika i svrhe u koju će se on upotrijebiti. Osim osnovnih simptoma bolesti, oboljeli od KRS-a opterećeni su i kompleksnim poremećajima od kojih su najvažniji poremećaji spavanja, umor, depresija i seksualna disfunkcija. Iako ne postoji jedinstveni lijek za KRS, liječenje značajno unaprjeđuje kvalitetu života. Nema značajne razlike između učinaka medikamentnog i kiruškog liječenja KRS-a, osim pri postojanju masivne nosne polipoze. Osim direktnog utjecaja na kvalitetu života, KRS na izravne i neizravne načine ostvaruje velik utjecaj na ekonomiju. Glavninu neizravnih učinaka i velik financijski problem čine izostanci s posla te smanjena učinkovitost zbog smanjene kvalitete života. Odgovarajuće liječenje značajno unapređuje kvalitetu života i umanjuje socioekonomski teret KRS-a.CRS (chronic rhinosinusitis) is defined as the inflammation of the nose and paranasal sinuses. Despite numerous studies and hypotheses related to its etiology, it remains poorly understood. CRS occurs in two clinical phenotypes: CRS with nasal polyps and CRS without nasal polyps, according to the endoscopic findings. It is among the most common chronic conditions. Prevalence od CRS is 5-15% in the urban community in Europe and USA. Major symptoms are nasal blockage, nasal discharge, facial pain or pressure and loss of smell. Factors associated with CRS are ciliary impairment, allergy, asthma, immunocompromised state, microorganisms, local host factors and aspirin sensitivity. Diagnosis of CRS is based on assessment of rhinosinusitis symptoms and endoscopy or imaging methods. CRS has negative impact on health-related quality of life. Quality of life has been characterized as the functional effects of an illness and its therapy, perceived by the patient and it needs to be measured in a valid way. Major quality of life instruments are generic and disease specific questionnaires. For choosing the adequate instrument, the relationship between the characteristics of the questionnaire and the purpose for which it should be used, should be considered. Besides from the basic rhinosinusal symptoms, CRS patients carry a burden of more complex quality-of-life issues, such as sleep disturbance, fatigue, depression and sexual dysfunction. Although the uniform managament of CRS does not exist, medical and surgical treatment significantly improve quality of life. Both kinds of treatment lead to a similar improvement on the quality of life of CRS patients except in cases of the massive nasal polyposis. Apart from the direct impair of patients health, CRS presents a significant socioeconomic burden as it causes many direct and indirect costs. Majority of the indirect costs and a major financial problem are absenteeism and presenteeism. Adequate treatment improves health related quality of life and reudces socioeconomic burden of CRS