Upper-airway symptoms are associated with cognitive impairment in patients with severe asthma

Introduction: Patients with severe asthma have been shown to have an increased prevalence of cognitive impairment (CI) compared with the general population. It is unknown if and to what extent the high prevalence of comorbid chronic rhinosinusitis (CRS) contributes to the observed CI.

Aims: To investigate associations between cognitive function, CRS and upper-airway symptoms in patients with severe asthma.

Methods: Patients about to commence biologic therapy for severe asthma as part of the 3TR-Asthma Biologics Cohort underwent testing. Objective cognitive functions were assessed using Screening for Cognitive Impairment in Psychiatry (SCIP) and the Trail Making Test-Part B (TMT). Subjective cognitive functions were assessed with the Cognitive Failures Questionnaire (CFQ) and upper-airway symptoms with the Sino-Nasal Outcome Test 22 (SNOT22).

Results: 61 patients underwent testing, n=37 (61%) had CRS and n=24 (39%) did not. There were no statistically significant differences between these groups regarding general (53% vs 43%) or selective CI (13% vs 17%) based on SCIP and TMT. A positive correlation was seen between scores in SNOT22 (Median=44) and the TMT (r=.32, p=.01) as well as in CFQ (r=.64, p<.001). No correlation was seen for the SCIP.

Conclusions: A diagnosis of CRS in severe asthma was not per se associated with CI, but with increasing severity of CRS symptoms, we found both symptoms and signs of CI to be increasingly pronounced. Our results suggest that significant concomitant affection of the upper airways contributes to more global effects, thereby adding to the cumulative burden of symptoms and highlighting the importance of a more holistic approach in assessing the impact of severe asthma.