Impaired small airway function in non‐asthmatic chronic rhinosinusitis with nasal polyps

Abstract

Background: There is clinical evidence for impaired lung function in chronic rhinosinusitis with nasal polyps (CRSwNP) patients, which may be due to a high incidence of asthma comorbidity. The lung function characteristics of non-asthmatic CRSwNP patients are not known. Small airway dysfunction (SAD) is involved in the pathogenesis of asthma. However, whether SAD is detected in non-asthmatic patients with CRSwNPs remains unclear. Objective: This study analysed the lung function of non-asthmatic patients with CRSwNPs and evaluated its clinical relevance in CRSwNPs. Methods: The clinical data for 191 consecutive CRSwNP patients (73 asthmatic and 118 non-asthmatic) and 30 control subjects were prospectively collected. The patients were followed up for at least 3 years (mean [standard deviation], 42.47 ± 8.38 months). Serum and tissue total IgE levels were measured in 95 and 93 patients, respectively. Tissue eosinophil counts were documented in 63 patients. Results: Non-asthmatic CRSwNP patients had decreased forced expiratory flow at 75% of the FVC (FEF 75) and FEF 50 compared to the control subjects, and this difference was related to the severity of CRSwNP. The risk factors for impaired lung function in asthmatic and non-asthmatic patients were duration of asthma and smoking. A multivariate logistic analysis showed that decreased FEF 50 was associated with the recurrence of non-asthmatic CRSwNPs. The lung function of CRSwNP patients negatively correlated with the degree of type-2 inflammation, which was defined by the levels of Eos and IgE in polyp tissues and blood. The SAD of non-asthmatic CRSwNP patients was related to serum IgE levels. Conclusions and clinical relevance: This study provides evidence that non-asthmatic CRSwNP patients may have SAD, which correlated with the severity and recurrence of CRSwNP. The decreased lung function of patients with CRSwNP was related to the degree of type-2 inflammation.

Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy

“…We have finally entered the much‐anticipated era of personalized medicine for asthma, and several articles evaluated biologics and the variation in individual response to these in people with asthma 25‐27 , 28‐36 , 37 , 38 Others evaluated more traditional treatments for asthma, such as corticosteroids or mechanisms that may underlie impaired airway function in asthma 39‐59 . New interventions studied in clinical trials included air cleaners, triple inhaler therapy, an oral prostaglandin D2 antagonist 60‐62 and other more preliminary data from various interventions, from cinnamon and bacterial peptides to allergen immunotherapy 63‐67 .…”

Clinical and cytokine patterns of uncontrolled asthma with and without comorbid chronic rhinosinusitis: a cross-sectional study

“…An increasing number of studies have provided consistent evidence that asthma is closely related to chronic rhinosinusitis (CRS), thus strongly supporting the united airway concept [ 4 , 5 ]. Indeed, about 50% of patients with CRS have comorbid asthma, whereas 40 ~ 75% of patients with asthma have comorbid CRS [ 3 , 6 ].…”

“…Indeed, about 50% of patients with CRS have comorbid asthma, whereas 40 ~ 75% of patients with asthma have comorbid CRS [ 3 , 6 ]. Although there is no direct evidence of causality between the two conditions, a direct correlation has nevertheless been found between CRS severity and asthma severity [ 4 , 7 ]. Although a recent study by Wu and colleagues [ 8 ] has demonstrated that the clinical phenotypes of patients with both nasal polyps and comorbid asthma (NPcA) could be divided into 3 clusters, mainly according to onset, duration and severity of symptoms, studies investigating phenotypes of asthma based on CRS comorbidity, severity of airflow obstruction and airway inflammation, and inflammation type of asthma using cluster analysis are scarce.…”

Involvement of the extracellular matrix proteins periostin and tenascin C in nasal polyp remodeling by regulating the expression of MMPs

“… 1 Compared with CRSsNP, CRSwNP manifests a higher disease severity and a higher risk of asthma comorbidity, and also showed a high risk for recurrence. 3 , 4 CRSwNP is characterized by the formation of edematous stroma and pseudocysts. 5 Evidence shows that tissue remodeling is one of the main causes of the formation of nasal polyps.…”

“…The prevalence of chronic rhinosinusitis with nasal polyps (CRSwNP) in Europe is estimated to be between 2.1% (France) and 4.4% (Finland) and is 4.2% in the United States 1 . Compared with CRSsNP, CRSwNP manifests a higher disease severity and a higher risk of asthma comorbidity, and also showed a high risk for recurrence 3,4 . CRSwNP is characterized by the formation of edematous stroma and pseudocysts 5 .…”