A Sinonasal‐Dominant Symptom Phenotype Is Associated With
COPD
Exacerbations: A Multicentre Cross‐Sectional Study
Tasuku Yamamoto, Kazuki Hamada, Yoshikazu Yamaji, Keiko Doi, Junki Suizu, Keita Murakawa, Yoriyuki Murata, Keiji Oishi, Maki Asami‐Noyama, Nobutaka Edakuni, Tomoyuki Kakugawa, Tsunahiko Hirano, Kazuto Matsunaga ABSTRACT
Background and Objective
Sinonasal symptoms are common in chronic obstructive pulmonary disease (COPD); however, their clinical significance remains unclear. This study investigated whether patient‐reported sinonasal symptoms are associated with COPD exacerbation history and whether multidimensional patient‐reported outcome (PRO) assessment identifies a distinct sinonasal symptom–dominant phenotype.
Methods
This multicenter cross‐sectional study included 442 patients with COPD. Sinonasal symptoms, COPD health status, and frailty were assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), COPD Assessment Test (CAT), and Kihon Checklist (KCL), respectively. Associations between the SNOT‐22 scores and COPD exacerbation history or frailty were evaluated using logistic regression analysis. Domain‐level analyses were performed using the previously reported SNOT‐22 domains. PRO‐based phenotyping was performed using unsupervised k‐prototype clustering of the SNOT‐22, CAT, and KCL items.
Results
Patient‐reported sinonasal symptoms were common, with discordance between patient and physician reports. Higher SNOT‐22 scores were associated with COPD exacerbation history and frailty. Domain‐level analyses showed that the nasal symptom domain was associated with exacerbation history, whereas the emotional domain was associated with frailty. PRO‐based clustering identified four clinically interpretable phenotypes, including a nasal symptom–dominant phenotype associated with COPD exacerbation history.
Conclusion
Patient‐reported sinonasal symptoms are common and clinically relevant in COPD, with discordance between patient and physician reports. This study identified a nasal symptom–dominant phenotype associated with COPD exacerbation history, highlighting the potential value of upper airway assessment in personalized COPD management and suggesting that sinonasal symptoms may represent a candidate treatable trait.