Chronic rhinosinusitis disease control: a review of the history and the evidence

ABSTRACT

Introduction

Control is an important concept and outcome measure for chronic incurable diseases, defined as the extent to which manifestations of a disease are within acceptable limits. Control reflects a global metric of disease status and serves as the goal of treatment. This review will encompass the history of the disease control concept applied to chronic rhinosinusitis (CRS) and the body of scientific literature that has focused on the definition of CRS disease control.

Areas covered

A review of the scientific literature identified historical studies and guidelines that have developed definitions of CRS disease control, as well as recent studies identifying the most significant determinants of CRS control. A particular focus was made on studies that investigated patients’ and physicians’ perspectives of CRS control.

Expert opinion

Patients and physicians have well-aligned perspectives about the definition, criteria, and application of CRS disease control, with a specific prioritization of patients’ assessments of their own CRS control, as well as the symptoms of nasal obstruction and nasal drainage. The development of future guidelines for assessing CRS control must be based on criteria supported by evidence as essential to the assessment of CRS control but should also be the subject of broad international consensus.

KEYWORDS:

• chronic rhinosinusitis
• control
• disease control
• outcome measure
• stakeholders
• perspectives

Article highlights

• CRS Control is defined as the degree to which manifestations of CRS are within acceptable limits.

• Achieving control of CRS is the goal of treatment for CRS.

• Despite there being several CRS control assessment tools, the definitions of CRS control used in the scientific literature are highly variable and CRS disease control is underutilized as an outcome measure.

• CRS patients understand the concept of CRS control, which they self-assess with consideration for many CRS manifestations, but most dominantly base this assessment on nasal symptom severity.

• In assessing patients’ CRS disease control, physicians prioritize patients’ assessments of their own CRS control above other CRS disease manifestations, but also highly weight the severities of nasal obstruction and nasal drainage.

• Patients’ and physicians’ perspectives of CRS control are well-aligned and both of these key stakeholder groups frequently have higher thresholds of disease burden to classify CRS as partly controlled or uncontrolled relative to established guideline recommendations.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer declares: speakers’ bureau for GlaxoSmithKline; <1-day Scientific advisor board meetings for Sanofi and GlaxoSmithKline. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.