COVID-19 as a turning point in the need for specialized units for the sense of smell

Background: The unprecedented prevalence of olfactory disfunction (OD) by SARS-CoV- 2 has revealed the lack of specialized units dealing with sense of smell. The main objective of the study is to know the number of newly created olfactory units (OU) since the COVID-19 pandemic, as well as to evaluate the diagnosis, management and treatment of patients with OD. Method(s): Prospective cross-sectional study. Carried out by means of a survey with 20 items: having or not having an OU, demographic data, smell test, evolution and management of OD, data on treatments. The variables of the survey were approved by the rhinology commission of the Spanish society of ENT. The digital survey was distributed to all members of Spanish ENT and Allergy Societies. Result(s): A total of 16 responses were missing data, and further 12 responses were duplicated. Finally, 136 surveys were included. From them 82.4% answers were from otolaryngologists and 17.7% from allergists. The cohort of allergists and otolaryngologists was compared to ensure comparability of both samples. There were significant differences in the instrumental assessment of the olfaction, VAS and smell test (p = 0.016) was more common in otolaryngologists. Also, the prescription of olfactory rehabilitation (OR) (p < 0.001) was more common in otolaryngologists. The 40.5% (+/- 7.6) of all the existent OU were created after COVID-19 pandemics. The 33.9% (+/- 4.5) of the respondent have an OU now, while 22.3% (+/- 3.9) already had it before COVID-19 pandemics. It means that 17% of hospitals who did not have an OU before COVID-19, now they have it, while 82.8% are still lacking it. OR was prescribed for 1-3 months by 38%;3-6 months by 48.1% and > 6 months by 13.9%. Those with an OU prescribe OR during more time (p = 0.002) being the most frequent answer 3-6 months (69.4%) when they have OU while 1-3 months (52.4%) for those who do not have it. Conclusion(s): This study revealed that COVID-19 pandemic has stimulated the creation of OU and has demonstrated the utility of OU to deal with patients with OD, as their daily practice is more adapted to up-to- date clinical evidence between allergist and otolaryngologists.

Smell improvement by anti-IgE and anti-IL 5 biologics in patients with CRSwNP and severe asthma. A real life study.

BACKGROUND AND OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by partial (hyposmia) or total (anosmia) loss of smell, is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), worsens disease severity and quality of life. Objectives. The objective of this study was to determine whether, in real-life conditions, biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare smell improvement in N-ERD and non-N-ERD subgroups. METHODS: A multicenter, non-interventional, retrospective, observational study was performed, including 206 patients with severe asthma undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab) with CRSwNP. RESULTS: Improved olfaction was found after treatment with all monoclonal antibodies: omalizumab (35.8%), mepolizumab (35.4%), reslizumab (35.7%), and benralizumab (39.1%), with no differences between groups. Patients with atopy, greater use of short course systemic corticosteroids, and larger polyp size were more likely to experience improvement in smell. The proportion of patients experiencing smell improvement was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. CONCLUSION: This is the first study to compare real-life improvement in sense of smell among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in sense of smell (with non-significant differences between biologic drugs). No differences were found in smell improvement between the N-ERD and non-N-ERD group.

The 8-Odorant Barcelona Olfactory Test (BOT-8): Validation of a New Test in the Spanish Population During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVE: Most smell tests are difficult to implement in daily clinical practice owing to their long duration. The aim of the present study was to develop and validate a short, easy-to-perform, and reusable smell test to be implemented during the COVID-19 pandemic. METHODS: The study population comprised 120 healthy adults and 195 patients with self-reported olfactory dysfunction (OD). The 8-Odorant Barcelona Olfactory Test (BOT-8) was used for detection, memory/recognition, and forced-choice identification. In addition, a rose threshold test was performed, and a visual analog scale was applied. The Smell Diskettes Olfaction Test (SDOT) was used for correlation in healthy volunteers, and the University of Pennsylvania Smell Identification Test (UPSIT) was used for patients with OD to establish cut-offs for anosmia and hyposmia. In order to take account of the COVID-19 pandemic, disposable cotton swabs with odorants were compared with the original test. RESULTS: In healthy persons, the mean (SD) BOT-8 score was 100% for detection, 94.5% (1.07) for memory/recognition, and 89.6% (0.86) for identification. In patients with OD, the equivalent values were 86% (32.8), 73.2% (37.9), and 77.1% (34.2), respectively. BOT-8 demonstrated good test-retest reliability, with agreement of 96.7% and a quadratic k of 0.84 (P<.001). A strong correlation was observed between BOT-8 and SDOT (r=0.67, P<.001) and UPSIT (r=0.86, P<.001). Agreement was excellent for disposable cotton swabs, with a k of 0.79 compared with the original test. The cut-off point for anosmia was ≤3 (area under the curve, 0.83; sensitivity, 0.673; specificity, 0.993). CONCLUSION: BOT-8 offers an efficient and fast method for assessment of smell threshold, detection, memory, and identification in daily clinical practice. Disposable cotton swabs with odorants proved to be useful and safe during the COVID-19 pandemic.

High frequency of smell and taste dysfunctions in allergy health care professionals suffering from COVID-19.

BACKGROUND AND OBJECTIVE: Since the first stages of the novel coronavirus 2019 (SARS-CoV-2) outbreak smell and/or taste dysfunction (STD), has been described from 5% to 88% in COVID-19 patients. Objective: we aimed to assess STD in healthcare professionals (HCP), mainly allergists, affected with COVID-19, by means of a survey, and to evaluate the association of STD and their severity with demographic characteristics, symptoms, comorbidities, and hospital admission. METHODS: A 15-item questionnaire was designed including different sections as follows: demographics, diagnostic characteristics, STD patterns, medication use as well as comorbidities. The questionnaire was developed using Google forms, implemented and distributed to members of the Spanish Society of Allergology and Clinical Immunology (SEAIC) and spread via Social Media to be completed by HCP affected with COVID-19. RESULTS: HCP (n=234), 76.5% ≤55 yrs, 73.5% female, completed the survey. There was STD in up to 74.4% of the respondents, 95.6% reporting a moderate-severe impairment. Mean recovery time of taste dysfunction was 21.6±24.0 days in HCP ≤55 yrs and 33.61±26.2 days in >55 yrs (p=0.019). Stratified analysis by severity of STD showed that more than a half of COVID-19 subjects presented severe loss of smell. An older age (>55 yrs) was associated with fever, anorexia, less headache and with a longer persistence of taste dysfunction. CONCLUSIONS: STD is a common symptom in COVID-19, even as a unique or preceding symptom. HCP who declared smell dysfunction (SD) were younger than those not affected with STD. Taste dysfunction (TD) may imply more systemic involvement in COVID-19-positive HCP.

Functional Examination of the Upper and Lower Airways in Asthma and Respiratory Allergic Diseases: Considerations in the Post-SARS-CoV-2 Era.

Airway examination procedures can potentially transmit infectious diseases to patients and to the health care professionals who perform them via various mechanisms. The COVID-19 pandemic has halted most of the activity of the clinics and laboratories involved in assessment of lung and nasal function, and clear recommendations in this regard have been made. Today, we still do not know for sure what its consequences will be in the short or long term, since important gaps remain in our knowledge of aspects as fundamental as virus transmission mechanisms, pathophysiology, immune response, and diagnosis. In this review, we study the examination techniques used to assess patients with respiratory allergy, asthma, and associated diseases during this period and highlight their possible advantages and disadvantages. Therefore, we focus on exploring the entire upper and lower airways, from the perspective of the safety of both health professionals and patients and their specific characteristics. We also analyze the intrinsic value of these interventions in terms of diagnosis and patient management. The changing situation of COVID-19 may mean that some of the assertions presented in this review will have to be modified in the future. While we seek to ensure a consistently broad approach, some differences in operational details may apply owing to local regulations.

Smell and Taste Dysfunction in COVID-19 Is Associated With Younger Age in Ambulatory Settings: A Multicenter Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). Objective: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment.

Olfactory Dysfunction in the COVID-19 Outbreak.

The first cases of coronavirus 2019 disease (COVID-19) occurred in Wuhan, China, and the disease rapidly become a public health emergency of international proportions. COVID-19 can cause mild-to-severe acute respiratory syndrome (SARS) and is caused by the SARS-CoV-2 coronavirus. The clinical manifestations of COVID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, sore throat, and headache. We performed this narrative review to analyze the current literature on postviral olfactory dysfunction related to the SARSCoV- 2 pandemic. Since the initial anecdotal reports from China, increasingly frequent international reports on COVID-19 indicate that 5% to 85% of affected patients lose their sense of smell, thus highlighting the very heterogeneous nature of the literature in this area. Therefore, we advise home isolation measures and/or social distancing, as well as tests to detect SARS-CoV-2 when possible, in patients with sudden and severe loss of smell who cannot be promptly evaluated.