Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with

Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

Value of The Sino-Nasal 5 quality of life

questionnaire (SN-5) as a screening tool in Children
with Uncontrolled Asthma
Raafat Abdel-Raouf Khattab*, Mustafa Muhammad Al-Sayed**, Sameh Abdul-Aziz
Ahmad Mansour*, Muhammad Ahmad Al-Gendy*.
*Pediatrics & **Otolaryngology Departments, Faculty of Medicine, Al-Azhar University, Cairo.

Abstract
Background: Up to 80% of asthmatic children may experience upper airway symptoms which are
often perceived as coming from the lower airways. Currently, there are no validated questionnaires
to assess upper airway contribution to pediatric asthma symptoms. The Sino-Nasal 5 (SN-5)
questionnaire was previously validated for identifying radiographic confirmed sinus disease in
children.
Objectives: In this study, we hypothesize that significant SN-5 scores (≥3.5) are associated with
abnormal GINA guidelines based asthma impairment and control in asthmatic children.
Methods: Based on SN-5 questionnaire completion results, patients were divided into two groups:
Group 1: had low scores <3.5 & Group 2: had significant scores ≥3.5, Retrospective data collected
on both group included age, sex, level of asthma symptom control, Childhood Asthma Control Test
(C-ACT) for children 4-11 years, Asthma Control Test (ACT) for children 12 years and older and
pulmonary function testing. Associations between SN-5 scores and asthma impairment and control
were identified.
Results: 63 children were evaluated; 47.6% were females with a mean age of 8.2 years. Significant
SN-5 scores were associated with decreased overall control of asthma symptoms (P< 0.001) and
increased night awakening (P< 0.001) and poor asthma control based on C-ACT and ACT (P< 0.001).
Conclusion: These results suggests that upper airway disorders such as allergic rhinitis and chronic
rhinosiusitis as identified by significant SN-5 scores (≥3.5) may play a larger role in impairment of
asthma symptom control, and there is inverse correlation between SN-5 scores and level of asthma
symptom control.

Key words: asthma; rhinosinusitis; allergic rhinitis; Sino-Nasal 5 score.

Introduction

Asthma is a heterogeneous disease, usually characterized by chronic airway

inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness
of breath, chest tightness and cough that vary over time and in intensity, together with
variable expiratory airflow limitation1.

Asthma is a serious global health problem affecting all age groups. Its prevalence is
increasing in many countries, especially among children. Although some countries have
seen a decline in hospitalizations and deaths from asthma, asthma still imposes an
unacceptable burden on health care systems, and on society through loss in productivity in
workplace and especially for pediatric asthma, disruption to the family1.

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

Comorbidity is the presence of one or more diseases or disorders occurring concurrently

with a primary disease or disorder. In asthma, comorbid conditions are frequently present,
and they add to the burden of respiratory symptoms associated with the primary condition.
They often contribute to a severe and difficult-to-treat asthma phenotype2.

Allergic rhinitis (AR) is one of the main comorbid conditions associated with asthma,
which is found in15% to 38% of patients with AR, and nasal symptoms are present in 6%
to 85% of patients with asthma. Patients with AR and severe asthma have poorer quality of
life, greater airway dysfunction and symptoms, and a greater number of hospital admissions.
They also have increased use of inhaled corticosteroids and bronchodilators3.

The Sino-Nasal 5 quality of life questionnaire (SN-5) is the only validated symptom
questionnaire for children and is completed by parents to measure Health Related Quality
of Life (HRQoL) for children with persistent Sino-nasal symptoms. The SN-5 has been shown
to have good test-retest reliability, construct validity, and responsiveness, suitable for use
in outcomes studies and routine clinical care4.

Poorly controlled asthma with significant SN-5 scores might lead to further identification
and better management of the upper airway, ultimately leading to improved control of
asthma symptoms and decreased need for asthma therapies 5.

The purpose of this study is to identify associations between The Sino-Nasal 5 quality
of life questionnaire (SN-5) scores and asthma impairment and control in children as defined
by GINA guidelines. We hypothesize that significant SN-5 scores (≥3.5) are associated with
abnormal GINA guidelines based asthma impairment and control in asthmatic children.

Patients and methods

This study was a retrospective review of collected data. It included 63 pediatric patients
(33 Males & 30 Females) aged 5-18 years with persistent Asthma coming to outpatient
Asthma clinic in Al-Hussein & Al-Sayed Galal university hospitals for evaluation and
treatment. The study was carried out from March 2018 to September 2018.

Inclusion criteria:
 Children aged 5 - 18 years
 Children with persistent Asthma, GINA guidelines 2018 updates were used for diagnosis,
classification of asthma severity and assessment of asthma control.
 All subjects had already been initiated on controller treatment, namely inhaled steroids
prior to their evaluation in the pulmonary clinic.
 Children were identified as having physician-diagnosed allergic rhinitis if either previously
diagnosed clinically or having recurrent symptoms at the time of visit (sneezing,
rhinorrhea, nasal obstruction, with or without facial itching).

2
 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

Exclusion criteria:
 Children aged < 5 years.
 Children with cardiac, immunologic, and rheumatologic disorders, as these comorbid
conditions may affect medical management and other primary outcomes.

The impact of upper airway disease was evaluated through completion of The Sino-
Nasal 5 quality of life questionnaire (SN-5) which was translated and modified into Arabic
language. It consists of five domains, including infectious symptoms, nasal obstruction,
allergy symptoms, emotional distress, and activity limitations. For each survey item
caregivers described how often during the past 4 weeks their child exhibited specific
symptom clusters using the following response scale: (1) none of the time, (2) hardly any
time at all, (3) a small part of the time, (4) some of the time, (5) a good part of the time, (6)
most of the time, and (7) all of the time. A 7-point ordinal scale has been shown to possess
adequate evaluative properties. An overall survey score was derived from the mean of all 5
items (range: 1.0 to 7.0)6. Based on previous validated studies, a significant SN-5 score was
defined as ≥3.5 out of a maximum of 77. These scores have been associated with
radiologically confirmed sinus disease8.

Figure 1 Sino-Nasal 5 questionnaire

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

Based on SN-5 questionnaire completion results, patients were divided into two groups:
 Group 1: had low scores <3.5
 Group 2: had significant scores ≥3.5

Both groups were subjected to the following:

 Thorough medical history including age, gender, daytime and night time symptoms,
associated medical or surgical problems, medications at time of initial consultation,
allergies, family and social histories.
 Full clinical examination including vital signs, chest examination for signs of
respiratory distress and audible wheeze as well as review of other systems. Body
mass index (BMI) was calculated and plotted on WHO BMI Z-Scores charts and
patients were classified accordingly into very thin (< -3SD), thin (< -2SD >), normal (≤
+1SD), overweight (> +1SD), and obese (> +2SD).
 Pulmonary function tests were performed to measure Forced Vital Capacity (FVC),
Forced Expiratory Volume in 1 second (FEV1) and FEV1/FVC ratio using calibrated
spirometer including specific predicted values for age and BMI. Both flow-volume
and volume-time spirograms are recorded. After three acceptable spirograms have
been obtained, the highest values of patient's personal best were used to conclude
test results.
 Complete blood count and chest x-ray for selected cases.
 Further assessment of asthma control utilized previously-validated standardized
questionnaires, including Childhood Asthma Control Test (C-ACT) for children 4-11
years old, and Asthma Control Test (ACT) for children 12 years or older. Both
questionnaires are consistent with The National Asthma Education and Prevention
Program (NAEPP) and GINA guidelines. A cut-off point of 19 for C-ACT and ACT
indicates uncontrolled asthma9.

Statistical analysis: A multivariate analysis was performed comparing SN-5 scores with
asthma impairment factors, pulmonary function tests and validated asthma questionnaires.
Collected data were verified, compiled, coded and statistically analyzed using SPSS v21.0.
(SPSS, Chicago, IL, USA).

Ethical considerations:
 Approval of the ethical committee in Pediatrics department and Al-Azhar faculty of
medicine was obtained before the study.
 Participants or their guardians were given informed consent that includes the aim and
steps of the study.
 The data of the patients and the results of the study are confidential and the patients
had the right to keep.
 The patient had the right to withdraw from the study at any time.
 The authors received no financial support for the research, authorship, and/or publication
of this study.

4
 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

Results

A total of 63 children with asthma were included in this study. Ages ranged from 5 to
18 years, with a mean age of 8.5 years. A total of 52.4% of the children studied were males
and 47.6% were females. Mean BMI was 18.6, with 4.8% of subjects were classified as very
thin, 4.8% as thin, 61.9% had normal BMI, 4.8% were overweight and 23.8% were obese
according to WHO BMI Z-Scores. 66.7% of patients had uncontrolled asthma symptoms
based on GINA guidelines for assessment of asthma symptom control.

Based on SN-5 questionnaire completion results, patients were divided into two groups:
Group 1 with low SN-5 score (<3.5) included 33 patients and Group 2 with significant SN-
5 scores (≥3.5) included 30 patients.

Table (1): Correlation between SN-5 scores and demographic characteristics

Characteristics Total Group 1 Group 2 P value

(N = 33) (N = 30)
Male 33 18 15
Sex 0.457
Female 30 15 15

Age 5-11 54 27 27
Age 0.288
Age ≥12 9 6 3

Very thin 3 0 3

Thin 3 0 3

BMI Normal 39 21 18 0.412

Overweight 3 0 3

Obese 15 12 3

BMI: Body Mass Index

Table 1 shows that there is no significant correlation between demographic data and SN-5
scores. As regard age (p = 0.288), sex (p = 0.457) and BMI (p = 0.412).

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

Table (2): Correlation between SN-5 scores and level of asthma symptom control
Level of asthma symptom Group 1 Group 2 P value
control (N = 33) (N = 30)
Well controlled 3 0

Partly controlled 18 0 <0.001

Uncontrolled 12 30

35
30
Number of patients

25
20
15
10
5
0
Well controlled Partly controlled Uncontrolled

SN<3.5 SN≥3.5

Figure 2 Correlation between SN-5 scores and level of asthma symptom control

Table 2 and Figure 2 shows that there is highly significant difference between both groups
regarding level of asthma symptom control (P < .001).

Table (3): Correlation between SN-5 scores and asthma symptoms

Reported asthma Group 1 Group 2 P value
symptoms (N = 33) (N = 30)
Daytime symptoms 27 24 0.88

Night awakening 15 30 < 0.001

Activity limitation 18 27 0.036

6
 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

35

30

Number of patients
25

20

15

10

0
Daytime symptoms Night awakening Activity limitation

SN<3.5 SN≥3.5

Figure 3 Correlation between SN-5 scores and asthma symptoms

Table 3 and Figure 3 show that there is a highly significant correlation between SN-5 scores
and increased night time awakening (P < .001) and a significant correlation between SN-5
sores and activity limitation (P = .036) but there is no significant correlation with daytime
symptoms (P = .88).

Table (4): Correlation between SN-5 Scores and Co-morbidities associated with asthma
Group 1 Group 2
Reported co-morbid condition Total P value
(N = 33) (N = 30)

Allergic rhinitis 39 9 30 <0.001

Eczema 12 9 3 0.453

Obesity 15 12 3 0.241

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

35

30

Number of patients
25

20

15

10

0
Allergic rhinitis Eczema Obesity

SN<3.5 (N = 33) SN≥3.5 (N = 30)

Figure 4 Correlation between SN-5 Scores and Co-morbidities associated with asthma

Table 4 and Figure 4 show that there is highly significant association between SN-5 scores
and allergic rhinitis (P < 0.001) and there is no significant association with other co-
morbidities, e.g. eczema (P = .453) & obesity (P = .241).

Table (5): Correlation between SN-5 scores and Pulmonary Function Tests
Pulmonary Function Group 1 Group 2 P value
Test (Mean) (N = 33) (N = 30)

FEV1 (L) 1.55 1.09 0.107

FEV1% 83.9 74.1 0.001

FVC (L) 1.73 1.45 0.264

FVC% 85 84.6 0.419

FEV1/FVC % 89.6 86.9 0.291

FEV1: Forced Expiratory Volume in 1 second; FVC: Forced Vital Capacity.

8
 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

100

% Mean of Pumonary Function Tets

90
80
70
60
50
40
30
20
10
0
FEV1% FVC% FEV1/FVC %

SN<3.5 SN≥3.5

Figure 5 Correlation SN-5 scores between and Pulmonary Function Tests

Table 5 and Figure 5 show that there is a significant association between SN-5 scores and
FEV1 % (P = 0.001). Other pulmonary function test results didn't demonstrate any statistical
significance.

Table (6): Correlation between SN-5 scores and ACT scores

Group 1 Group 2 P value
(N = 33) (N = 30)

ACT score (Mean) 18.6 14.4 <0.001

ACT: Asthma Control Test

6
Sino-nasal 5 Quality of Life

5
Questionnaire (SN-5)

0
0 5 10 15 20 25 30
Asthma Control Test (ACT)

Figure 6 Correlation between SN-5 scores and ACT scores.

Table 6 and Figure 6 shows that there is a highly significant inverse correlation between
SN-5 scores and Asthma control test scores (r -0.484, P < 0.001).

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

Discussion
As a previously validated screening tool, the SN-5 questionnaire is an effective, low-
cost and easily acceptable test to identify a disease that is commonly associated with upper
airway comorbidities -including allergic rhinitis and chronic rhinosinusitis- that are not
routinely screened.

While previous studies have looked at the use of the Sino-Nasal questionnaire in
relation to surgical interventions and radiological procedures, this study aimed to identify
the impact of upper airway symptoms on control of asthma in children.

Overall, we found our population characteristics were similar to previous studies on

pediatric asthma. Demographic data suggests an association between asthma with male
sex and higher BMI Values. This is in keeping with previously-published research10,11.

The SN-5 questionnaire was subsequently applied to collected data through a blinded
review independent of the physician diagnosing rhinitis.

When assessing asthma symptoms, current validated scoring systems are in place to
evaluate the lower airways, but fail to adequately assess the effects of the upper airway. In
our study, asthma impairments seen in nighttime- and activity-related symptoms were
associated with a significant SN-5 score. This reflects contribution of upper airway to these
two symptom domain which was confirmed on previous studies.

It has been established that sleep disturbance and increased night awakening is a
common complaint among patients with inflammatory diseases of the upper airways such
as allergic rhinitis (AR) and chronic rhinosiusitis (CRS). It is generally assumed that any
condition resulting in inflamed and enlarged nasal turbinate such as AR or CRS, will result
in nasal air passage obstruction and sleep disruption12.

A questionnaire based study was conducted to examine the role of allergic rhinitis (AR),
as comorbid condition of asthma, on children’s sleep problem. Frequency of sleep
disordered breathing and daytime sleepiness was associated with worse AR control. Also
total sleep problems scores differed by AR severity level. Post hoc analyses indicated sleep
problems were higher in children with severe AR than those with mild AR 13.

Previous publications have identified a substantial increase in functional and activity

limitations due to CRS and AR. Both CRS and AR impart significantly increased odds ratios
for activity, work, and social limitations. CRS is associated with more workdays lost than is
AR14.

We also found significant SN-5 scoring to be associated with decreased asthma

control, as seen on C-ACT and ACT questionnaires. Both questionnaires are validated tools
for assessing disease control in children with asthma and demonstrate good agreement with
GINA guidelines.

10
 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

Similar findings were observed in a questionnaire-based study that was conducted to

investigate the correlations between results from CRS- and asthma-specific questionnaires.
These questionnaires included the Sino-Nasal Outcome Test-22 (SNOT-22), the Rhino-
conjunctivitis Quality of Life Questionnaire (RQLQ), and the Asthma Control Test (ACT). The
SNOT-22 and RQLQ tools provide validated self-reported measures of symptom severity
and health-related QoL among patients with sinonasal conditions. There were significant
correlations between the results from the Asthma Control Test (ACT) and the Sino-Nasal
Outcome Test-22, as well as between the results of the ACT and Rhinoconjunctivitis Quality
of Life Questionnaire15. This suggests that SN-5 may be an important adjunct tool when
assessing asthma severity and control.

Higher SN-5 scores were associated with allergic rhinitis in keeping with previous
validation studies looking at upper airway disease often concomitant in asthma, notably
allergic rhinitis16.

When looking at the rest of the respiratory system, the SN-5 questionnaire did not
accurately reflect other clinically-diagnosed comorbidities that were not directly related to
the upper airway. It should be noted that not all subjects underwent allergy testing to confirm
allergic rhinitis, but rather were defined as having allergic rhinitis based on symptoms and
history (i.e., physician-diagnosed), which is an acceptable practice both clinically and in
terms of research17. As expected, comorbidities such as eczema, and obesity were not
accurately identified through SN-5 assessment.

We also tried to identify associations between SN-5 scoring and pulmonary function
tests. We found significant association between FEV 1 % of predicted for age, sex and BMI
and SN-5 scores. Those patients with lower FEV 1 % indicating more air flow limitations had
significant SN-5 scores indicating more troublesome upper airway disease. This is in
keeping with previous studies performed to measure and compare pulmonary function tests
in patients with allergic rhinitis and asthma. Nevine El-Helaly et al18 stated that a substantial
proportion of children with allergic rhinitis have impaired pulmonary functions. Patients with
both asthma and rhinitis show an increase in asthma severity and have the worst pulmonary
functions with great improvement by proper treatment of allergic rhinitis and asthma. Other
parameters of pulmonary function test didn't show significant association with SN-5 scoring.

To further delineate the effect of upper airway disease on lung dynamics a previously
published study found that Severe asthma patients with CRS had better improvements in
FVC and FEV1 3 months after nasal surgery19.

There are several limitations of our study. As a retrospective study, we are limited to
identifying associations and are unable to define causality of our findings. An increase in
population size will help elucidate any further correlation. In the future, we recommend a
prospective study in a larger cohort using stringent definitions for collected data to further

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Al-Azhar Journal of Ped. Vol.22 No.44 April, 2019

validate the observations of this study. Specifically, to evaluate whether using SN-5 in an
asthma population leads to medical interventions for the upper airway, and subsequent
decrease in upper airway and asthma symptoms.

With respect to using physician-diagnosed allergic rhinitis to describe the co-morbidity

noted to be associated with this questionnaire, in future studies it would be beneficial to
include objective testing (skin prick testing, serology) to help define allergic rhinitis, or at
least use it as a separate variable when describing the patient population. Additionally, if
asthma symptoms are decreased, it would be interesting to see if this could then lead to a
decrease in asthma therapies without loss of asthma control.

Conclusion

In asthmatics that lack control despite appropriate medical management, evaluating

comorbidities is essential, and the SN-5 questionnaire can draw appropriate attention to AR
and the upper airway. As our results suggest, identification of upper airway symptoms and
their contribution to perceived asthma symptoms can be addressed with use of the SN-5 in
children with asthma. This may lead to an overall perceived improvement in asthma care
and subsequent decrease in the need for asthma therapies.

Recommendations

 We recommend that primary pediatric providers use SN-5 questionnaire in a similar

fashion as other routinely-used validated questionnaires for asthma control to help
identify upper airway symptoms and conditions. This would allow providers to
subsequently initiate and monitor medical management for nasal and sinus symptoms
while continuing asthma treatment.
 In pediatric patients with positive SN-5 questionnaires, medical management should be
initiated with further referral to otolaryngology and allergy in instances where symptoms
persist.
 From a practical standpoint, SN-5 can be a less expensive indicator to appropriately start
rhinosinusitis treatment and minimizing asthma therapies, with referral to subspecialists
for those patients in whom SN-5 scoring does not improve on reassessment after
initiation of CRS medications.

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 Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with
Uncontrolled Asthma
Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.

References

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2018. Available from: www.ginasthma.org
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severe asthma. Med J Aust. 2018;209(2):11-17.
3. Wu TJ, Chen BY, Lee YL, et al. Different severity and severity predictors in early-onset
and late-onset asthma: A Taiwanese population-based study. Respiration. 2015;90:384-
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K., & Pillai, D.K. Sino-Nasal 5 Questionnaire is Associated with Poor Asthma Control in
Children with Asthma. Children 2017;28:4(7).
6. Kay DJ, Rosenfeld, RM. Quality of life for children with persistent sinonasal symptoms,
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Global Initiative for Asthma (GINA) criteria with the Childhood Asthma Control Test (C-
ACT) and Asthma Control Test (ACT). Eur Respir J; 38: 561–566.
10. Xanthopoulos, M.; Tapia, I.E. Obesity and common respiratory diseases in children.
Paediatr Respir Rev 2016, 30, 601–608.
11. Wael B. Halim, Khalil A. Khalil, Sobhy A. Sobhy and Seham A. Hasb-Allah. Prevalence of
Bronchial Asthma Among Secondary Schools Students at Abu Khalifa Village-Ismailia
Governorate. Med. J. Cairo Univ 2013; 81(2): 19-24.
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CA, Seifer R, Fritz GK, Klein RB. Asthma, allergic rhinitis, and sleep problems in urban
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16. Lehrer-Coriat, Mariño-Sánchez, Alobid & Mullol. Quality of life measures in patients on
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14
 ‫‪Value of The Sino-Nasal 5 quality of life questionnaire (SN-5) as a screening tool in Children with‬‬
‫‪Uncontrolled Asthma‬‬
‫‪Muhammad Ahmad Al-Gendy, Raafat Abdel-Raouf Khattab, Mustafa Muhammad Al-Sayed, Sameh Abdul-Aziz Ahmad Mansour.‬‬

‫قيمة استبيان "النف والجيوب النفية الخماس" كأداة اختبار ف‬

‫الطفال الذين يعانون من الربو‬
‫غي المنضبط‬‫ر‬
‫رأفت عبد الرؤف خطاب*‪ ،‬مصطفى محمد السيد**‪ ،‬سامح عبد العزيز أحمد منصور*‪ ،‬محمد أحمد الجندي*‬
‫*قسم طب األطفال **قسم جراحة األنف واألذن والحنجرة ‪ -‬كلية الطب ‪ -‬جامعة األزهر‬

‫تشير الدراسات اإلحصائية الى أن انتشار حساسية األنف والتهاب الجيوب االنفية في‬
‫األطفال الذين يعانون من الربو الشعبي قد تصل نسبته إلى ‪ .٪ 68-55‬ويرتبط وجود حساسية‬
‫االنف كذلك مع البداية المبكرة لظهور أعراض الربو عند األطفال‪ .‬في الوقت الحالي ‪ ،‬ال توجد‬
‫استبيانات لتقييم مدى تأثير أمراض الجهاز التنفسي العلوي كحساسية األنف والتهاب الجيوب األنفية‬
‫على انضباط أعراض الربو الشعبي عند األطفال‪.‬‬

‫يستخدم إستبيان األنف والجيوب األنفية الخماسي لتقييم ومتابعة مرض الجيوب األنفية‬
‫لدى األطفال وهو أداة معتمدة لتقييم تغيرات الحالة المعيشية في األطفال الذين يعانون من‬
‫أعراض األنف والجيوب األنفية بصورة مزمنة‪.‬‬

‫تهدف هذه الدراسة إلى إيجاد عالقة بين درجات تقييم استبيان األنف والجيوب األنفية‬
‫الخماسي ومدى انضباط أعراض الربو الشعبي عند األطفال‪.‬‬

‫تم تقييم ‪ 63‬طفال يعانون من الربو الشعبي من خالل هذه الدراسة بلغ متوسط أعمارهم‬
‫‪ 8.2‬سنوات وتم تقييم مدى انضباط الربو الشعبي لديهم كما تم استكمال استبيان األنف والجيوب‬
‫األنفية من قبل أولياء األمور ومقدمي الرعاية وتبين وجود عالقة ذات داللة احصائية بين درجات‬
‫تقييم اإلستبيان وبين درجة انضباط أعراض الربو الشعبي‪.‬‬

‫تشير هذه النتائج إلى أن الجهاز التنفسي العلوي قد يلعب دورًا أكبر في معدل ظهور‬
‫أعراض الربو الشعبي ومدى حدتها‪ ،‬وقد يكون استبيان األنف والجيوب االنفية الخماسي مفيدًا‬
‫في تقييم مساهمة أمراض الجهاز التنفسي العلوي في السيطرة على الربو‪.‬‬

‫توصي الدراسة باستخدام استبيان األنف والجيوب األنفية الخماسي بصورة دورية في‬
‫األطفال الذين يعانون من الربو الشعبي لتقييم أعراض الجهاز التنفسي العلوي ومدى تأثيره على‬
‫أعراض الربو الشعبي‪ ،‬وكذلك استخدامه في متابعة مدى استجابة أعراض الربو الشعبي عند‬
‫تعديل خطة العالج لتشمل حساسية األنف والتهابات الجيوب األنفية‪.‬‬

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