A recent report published in the Journal of Allergy and Clinical Immunology found that older patients with chronic sinusitis have a unique inflammatory sign which may render them less responsive to steroid treatment. This study was published by Vanderbilt researchers.
Chronic sinusitis is a disease of the nasal cavity and paranasal sinuses which often persists over years. In this condition cavities around nasal passages (sinuses) become irritated and swollen for about 12 weeks, even with treatment attempts. It is also known as chronic rhinosinusitis.
The researchers examined the tissue and mucus specimens of 147 patients between the ages of 18 to 78. They all required sinus surgery for their chronic sinusitis.
Initially, researchers identified the subgroups of patients on the basis of their inflammatory signature, the different cytokines and inflammatory proteins in tissue or mucus. By doing so, Vanderbilt investigators recognized that one of the identified subgroups was enriched in patients over age 60.
Fascinated by the outcomes, the research team compared the patients according to age by examining their histopathology, tissue specimens taken during surgery. Also, the immune indicators and inflammatory proteins found in their mucus and tissue. Researchers noticed that they were strikingly different.
Findings of the study
A research team found that most chronic sinusitis in North America, a kind that requires surgical intervention. It has an inflammatory sign characterized by a set of cytokines related to allergy and asthma called Th2-associated cytokines.
Older patients incline to not have major elevations of those cytokines. On the other hand, they have a boost of cytokines associated with the body’s innate immune role and both acute and chronic inflammatory responses, and that is greatly dependent on age.
Researchers found that patients don’t see an elevation in those cytokines until around age 60. And then from that age on, there is a progressive rise in the levels of those cytokines seen in the tissue and the mucus.
Because of this difference, older patients would hypothetically be less probable to respond to the steroids. The steroids which are used to treat chronic sinusitis characterized by Th2-associated cytokines.
They found that the topical steroids like nasal sprays and irrigations are deeply relied upon for long-term management of disease and symptom.
Chronic sinusitis management
Researchers are just hoping that this data will excite interest in the elderly people regarding chronic sinusitis management. Because it proposes that we may need patient-specific treatments targeting these patients.
This is particularly significant as steroids can have short- and long-term adverse effects. These side effects are more possible in older patients than they are in younger patients.
For the confirmation of these findings, Turner’s team is presently using data collected over the last some years to relate surgical outcomes based on age.
Initial data advocate that older patients have less apparent benefit from sinus surgery as compared to younger patients. It indicates that their disease is different. Therefore, their post-operative medical management options may be less likely to provide any relief.
However, researchers are looking for better ways to treat this disease and to understand it a little better. It seems to be that they have identified a characteristic of a large population of patients which may eventually change our dealing of those patients going forward. It at least recommends that more research targeted at that population is needed.