A Sinonasal‐Dominant Symptom Phenotype Is Associated With COPD Exacerbations: A Multicentre Cross‐Sectional Study

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.