Prospective analysis of CT of the sinuses in acute asthma

OBJECTIVE. Asthma and sinusitis are both inflammatory disease of the respiratory epithelium, but to our knowledge no prospective analyses of CT of the sinuses in patients with acute asthma have been performed. The purpose of this study was to investigate the type and extent of abnormalities found on CT of the sinuses in patients with acute asthma. SUBJECTS AND METHODS. Sixty-five patients with acute asthma and 62 age-, race-, and sex-matched control subjects were enrolled in the emergency department. Limited coronal sinus CT was performed and scans were interpreted by a radiologist who was unaware of the patient's clinical condition. Scans were analyzed for the presence of mucosal thickening in the sinuses, ostiomeatal complexes, and nasal cavities. Scans were also assigned a CT score for total mucosal thickening. A CT score of 12 or more points indicated extensive disease. RESULTS. Mucosal thickening in the nasal passages (p <.001), ostiomeatal complexes (p <.05), and ethmoidal (p <.05) and sphenoidal sinuses (p <.05) was associated with acute asthma, but maxillary mucosal thickening was not (p =.44). CT scores differed significantly between asthmatic patients (7.7 +/- 0.8 points) and control subjects (4.1 +/- 0.4 points) (p <.001). Nineteen of the 65 asthmatic patients had extensive disease compared with two of the 62 control subjects (p <.001). Thirteen asthmatic patients with extensive disease underwent follow-up CT 5 months later, and 11 of the 13 patients showed improvement in CT score without having undergone specific therapy for sinusitis. CONCLUSION. Mucosal thickening in the nasal passages and sphenoidal, ethmoidal, and frontal sinuses is more common in patients with acute asthma than in control subjects. However, maxillary sinus mucosal thickening is no more common in asthmatic patients than in control subjects.