Childhood Respiratory Conditions Linked to Adult Chronic Rhinosinusitis, suggests study

CRS is a chronic inflammatory condition of the sinuses that significantly affects the quality of life of millions of individuals worldwide, generally with symptoms of nasal obstruction and facial pain. Although very common, the risk factors related to early life in the development of adult CRS are not so well understood. For example, the Tasmanian Longitudinal Health Study provides an exemplary cohort initiated in 1968 for investigating life course associations.

This study particularly examined the relationships between childhood conditions of respiratory infections and allergies and the incidence of CRS in middle age. It also took into consideration asthma and allergies during the course and their impact on the risk of CRS.

In this study, the included participants of the TAHS cohort were first studied in 1968 at age 6-7 years (n = 8583) and followed into middle age (n = 3609). At age 53, participants were categorized into CRS severity subtypes: no sinusitis/CRS, past doctor diagnosis only, current symptoms without doctor diagnosis, and doctor-diagnosed CRS with current symptoms. Using multinomial regression, it examined associations with childhood respiratory conditions and previously published asthma-allergy trajectories from ages 7 to 53 years.

In middle age, 5.8% of participants reported current CRS symptoms, with 2.5% having a doctor diagnosis. Significant childhood conditions associated with symptomatic doctor-diagnosed CRS included:

• Frequent head colds: mOR = 2.04 (95% CI: 1.24, 3.37)

• Frequent tonsillitis: mOR = 1.61 (95% CI: 1.00, 2.59)

• Current childhood asthma: mOR = 2.23 (95% CI: 1.25, 3.98)

Life course trajectories with late-onset or persistent asthma and allergies were associated with all CRS subtypes in middle age. Notably, early-onset persistent asthma and allergies had a significant association with symptomatic doctor-diagnosed CRS:

• Early-onset persistent asthma and allergies: mOR = 6.74 (95% CI: 2.76, 16.4)

• Late-onset asthma allergies: mOR = 15.9 (95% CI: 8.06, 31.4)

• Late-onset hayfever: mOR = 3.02 (95% CI: 1.51, 6.06)

These findings indicate that children who have frequent respiratory infections and asthma run a higher risk of contacting CRS at middle age. The research puts forth the importance of very early and active management of respiratory conditions in childhood, which probably would reduce the risk of CRS at old age. Persistent and late-onset asthma and allergies are robust predictors for adult CRS, underpinning their interrelationship across the life course.

The current asthma, frequent head colds, and tonsillitis at age 7 are indicators of a higher risk for CRS in mid-adult life. These results call for close follow-up and early interventions on childhood respiratory morbidity in order to reduce long-term risks. Concomitant asthma and allergy are treatable traits whose management in childhood may lighten the burden of CRS in adulthood.

Reference:

Perret, J. L., Idrose, N. S., Walters, E. H., Bui, D. S., Lowe, A. J., Lodge, C. J., Fernandez, A. R., Yao, V., Feather, I., Zeng, X.-W., Thompson, B. R., Erbas, B., Abramson, M. J., & Dharmage, S. C. (2024). Childhood infections, asthma and allergy trajectories, and chronic rhinosinusitis in middle age: A prospective cohort study across six decades. Allergy. https://doi.org/10.1111/all.16184