Airway dysfunction in nasal polyposis: a spectrum of asthmatic disease?

• Published in: Clinical and experimental allergy 2011-10, Vol.41 (10), p.1379-1385
• Main Authors: Williamson, P. A., Vaidyanathan, S., Clearie, K., Barnes, M., Lipworth, B. J.
• Format: Article
• Language: English
• Subjects: Adult; Allergies; Asthma; Asthma - diagnosis; Asthma - immunology; Asthma - physiopathology; Biological and medical sciences; Blood; Bronchi - physiopathology; Bronchial Hyperreactivity - diagnosis; Bronchial Hyperreactivity - pathology; Bronchial Hyperreactivity - physiopathology; Chronic Disease; Chronic obstructive pulmonary disease, asthma; Endoscopy; Eosinophilia; Eosinophils - immunology; Eosinophils - pathology; Exhalation; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hypersensitivity; Immunoglobulin E; Immunoglobulin E - blood; Inflammation; Leukocytes (eosinophilic); Male; Medical sciences; methacholine; Middle Aged; Multivariate analysis; nasal polyps; Nasal Polyps - complications; Nasal Polyps - pathology; Nasal Polyps - physiopathology; Nitric oxide; Nitric Oxide - analysis; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Pneumology; polyposis; Respiratory Function Tests; Respiratory tract; Respiratory tract diseases; Rhinitis - complications; Rhinitis - pathology; Rhinitis - physiopathology; rhinosinusitis; Sampling; sinusitis; Sinusitis - complications; Sinusitis - pathology; Sinusitis - physiopathology; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1111/j.1365-2222.2011.03793.x

Summary Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an interesting model to investigate the existence of a non‐allergic unified airway. The factors associated with airway dysfunction in CRSwNP are not fully understood. Objective To assess the impact of nasal disease on lower airway dysfunction in CRSwNP. Methods Fifty‐seven patients with CRSwNP underwent spirometry, nasal endoscopy, exhaled nitric oxide, methacholine bronchial challenge, blood sampling for total IgE, eosinophil count and radioallergosorbent testing (NCT00788749). Three phenotypic groups were identified: ‘asthma group’ (asthma diagnosis); ‘inflammatory group’ [no asthma diagnosis, but elevated fractionated exhaled nitric oxide (FENO) and/or bronchial‐hyperreactivity (BHR)]; and ‘non‐inflammatory group’ (no asthma diagnosis, no BHR and normal FENO). Group comparisons, univariate and multivariate analyses were performed to examine associations with airway dysfunction. Results FEV1 and FEF25−75% were reduced in asthma, but there was no difference between the non‐asthmatic groups. Total IgE and eosinophils were elevated in asthma vs. the non‐inflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV1 (P