Association between chronic rhinosinusitis and health-related quality of life in adults with cystic fibrosis

Objectives: In the past four decades, the median age of survival has nearly doubled for individuals with cystic fibrosis (CF), where over half the population is now adults. The prevalence of chronic diseases such as chronic rhinosinusitis (CRS) has increased with older age. In the non-CF population, CRS is associated with reduced health-related quality of life (HRQoL). Our objectives were to determine the prevalence of CRS among adults with CF and evaluate its impact on their HRQoL. Methods: One hundred sixty individuals from an academic teaching hospital in Vancouver, Canada were eligible to participate in this cross-sectional study. Included subjects were above the age of 18 years, had a confirmed diagnosis of CF and attended the CF clinic between September 2013 and April 2014. Participants completed a CF-specific HRQoL questionnaire (i.e. CFQ-R 14+), and underwent symptom and endoscopic assessment to diagnose CRS. Medical charts were reviewed for potential confounders that included socio-demographic (age, gender and body-mass index) and clinical factors (age of CF diagnosis, type of CF mutation, lung function and chronic Pseudomonas aeruginosa infection). Multivariable linear regression was used to model the relationship between CRS and HRQoL, adjusted for potential confounders. Results: One hundred twenty-one individuals were contacted prior to clinic visits of which, 113 (93.4%) consented to participate. The prevalence of CRS was found to be 64.2%. Socio-demographic and clinical factors were similarly distributed between CRS-positive and negative groups, except age of CF diagnosis. CRS-positive individuals were diagnosed with CF at younger age than non-CRS counterparts, although this finding was not significant (mean difference: 6.5 years, p=0.13). In unadjusted analysis, those with CRS reported worse HRQoL on 10 of 12 domains of the CFQ-R 14+. These findings remained despite adjustment for potential confounders. Individuals with CRS reported significantly worse HRQoL on Respiratory symptoms (adjusted regression coefficient: -13.33, p=0.001) and Digestion (adjusted regression coefficient: -8.71, p=0.03) domains, than non-CRS counterparts. Conclusion: The majority of adults with CF suffer from concomitant CRS. CRS is associated with worse HRQoL based on multiple domains of the CFQ-R 14+. CRS should be diagnosed and managed to optimize the HRQoL for adults with CF.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat