A LARGE Swedish population study has found strong associations between chronic rhinosinusitis (CRS) and chronic airflow limitation (CAL), lower airway symptoms, and smoking-related lung diseases, highlighting the need for a holistic approach to airway inflammation.
The study analysed data from 30,154 adults aged 50–64 years who participated in the Swedish CArdioPulmonary bioImage Study (SCAPIS). Spirometry was performed after bronchodilation to assess lung function, with CAL defined as an FEV1/FVC ratio below 0.7. Participants underwent thoracic computed tomography to identify emphysema and completed a detailed questionnaire on CRS, smoking history, and respiratory conditions such as asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Multivariable regression models were used to evaluate the relationship between CRS and airway disease.
CRS was present in 5.6% of participants and was more common in those with CAL (7.6%), lower airway symptoms (15.7%), and chronic bronchitis (24.5%). CRS prevalence was higher among current smokers (8.2%) compared to non-smokers and showed a strong association with COPD, affecting 17.6% of never-smokers and 15.3% of ever-smokers with the condition. Emphysema was present in 6.7% of individuals with CRS. Adjusted regression analysis confirmed significant associations between CRS and CAL (odds ratio [OR]: 1.40), lower airway symptoms (OR: 4.59), chronic bronchitis (OR: 6.48), asthma (OR: 3.08), and COPD (OR: 3.10).
These findings emphasise the interconnected nature of upper and lower airway inflammation and suggest that CRS should be considered a marker for broader respiratory dysfunction. Clinicians managing CRS should be vigilant for coexisting lower airway disease, particularly in smokers and those with chronic respiratory symptoms.
Reference
Andersson A et al. Chronic Airflow Limitation, Lower Respiratory Symptoms, COPD and Chronic Rhinosinusitis in a Middle-Aged Population: The Swedish CArdioPulmonary bioImage Study (SCAPIS). A Link Between the Lower and Upper Airways. Int J Chron Obstruct Pulmon Dis. 2025:20:273-86.
