Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

Kanda, Akira; Kobayashi, Yoshiki; Asako, Mikiya; Tomoda, Koichi; Kawauchi, Hideyuki; Iwai, Hiroshi

doi:10.3390/medsci7020027

Cited by 29 publications

(22 citation statements)

References 57 publications

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“…For topical steroid treatments, a method of exhalation through the nose of inhaled steroids, a retronasal delivery system, has been reported to be useful for patients with eosinophilic chronic rhinosinusitis and comorbid asthma as an airway medicine that simultaneously treats inflammation of both the upper and lower respiratory tract. 27,28 The therapeutic effects of sinonasal topical steroid treatment were also demonstrated in the present study. When the patient's symptoms are resistant to post-operative steroid treatment, 29 further revision surgery to remove the inflamed lesions and residual cells 7 or biological therapies without serious adverse events, such as dupilumab, 30,31 should be considered for intractable eosinophilic chronic rhinosinusitis.…”

Section: Discussionsupporting

confidence: 79%

Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

et al. 2021

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Objective This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis. Method Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not. Results Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01). Conclusion These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis.

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Section: Discussionsupporting

confidence: 79%

Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

et al. 2021

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“…The upper airway, such as the nasal cavity and paranasal sinuses, and the lower airway, such as the bronchi and lungs, are anatomically connected and recognized as the "united airway" [ 10 ]. The upper and lower airways are susceptible to functional interactions through hematogenous, transbronchial, and neuromodulatory communication of inflammatory mediators [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Real-life effectiveness of dupilumab in patients with mild to moderate bronchial asthma comorbid with CRSwNP

et al. 2022

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Background Dupilumab, an anti-IL-4α receptor antibody, is a new treatment for severe or refractory asthma. However, real-world evidence on the efficacy of dupilumab in patients with mild to moderate bronchial asthma is lacking. Methods We retrospectively evaluated the effects of dupilumab in 62 patients who received dupilumab for eosinophilic sinusitis comorbid with asthma at a single centre in Japan. Type 2 inflammatory markers, ACT, respiratory function tests, and forced oscillation technique (FOT) were analysed before, three months after, and one year after dupilumab administration, mainly in patients with mild to moderate asthma. Results FEV1, %FEV1, %FVC, treatment steps for asthma and ACT improved significantly after three months of dupilumab treatment. FeNO was markedly decreased, whereas IgE and eosinophil counts showed no significant changes. Pre- and post-treatment respiratory resistance (Rrs) and respiratory reactance (Xrs) correlated significantly with FEV1. Improvement in %FEV1 was associated with higher FeNO and higher serum IgE before dupilumab treatment. Conclusion Dupilumab treatment for sinusitis may improve respiratory functions, asthma symptoms, and asthma treatment reduction, even if the associated bronchial asthma is not severe.

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“…The concept of combined airways or “one airway, one disease” is well known and supported by the observation that AR and asthma are often associated and share similar immunopathological features. 36 37 38 In our previous work, we found that the nasal lavage eosinophil count correlated with sputum eosinophil count, FeNO, FEV1%, and PD 20 6 hours after NPT. 15 Similarly, in the current study, we found that sputum eosinophil count was significantly correlated with nasal lavage eosinophil count in non-AIT subjects both at baseline and after 6 hours of NPT.…”

Section: Discussionmentioning

confidence: 81%

Effect of Dermatophagoides pteronyssinus Immunotherapy on Upper and Lower Airway Eosinophilic Inflammatory Response to Nasal Allergen Challenge

Huang

Qin

et al. 2020

Allergy Asthma Immunol Res

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Purpose It remains unknown whether allergen-specific immunotherapy (AIT) could attenuate airway inflammatory response triggered by allergen exposure. Methods We performed Dermatophagoides pteronyssinus ( Der-p ) nasal provocation tests (NPTs) in allergic rhinitis (AR) and/or asthma patients without AIT (non-AIT), or at 16, 52, 104, or 156 weeks after Der-p AIT. Rhinitis and asthma visual analog scale (VAS; VAS of nasal symptoms [VAS-NS], VAS of asthma symptoms), the rhinoconjunctivitis quality of life questionnaire (RQLQ), nasal lavage, sputum induction, fractional exhaled nitric oxide (FeNO), nasal airway resistance, pulmonary function, and airway hyperresponsiveness were performed before and after NPT. Results Non-AIT subjects demonstrated significantly higher VAS-NS before and after NPT compared to AIT subjects ( P < 0.05). NPT response was positive in 14 (100%) non-AIT, 7 (70%) 16 weeks-AIT, 6 (60%) 52 weeks-AIT, 6 (60%) 104 weeks-AIT, and 2 (20%) 156 weeks-AIT subjects. The NPT grade significantly correlated with AIT duration and baseline RQLQ score ( r = −0.561, P < 0.001 and r = 0.525, P < 0.001, respectively). Sputum and nasal lavage eosinophil count, and FeNO in non-AIT subjects were significantly increased 6 hours after NPT ( P < 0.05). AIT subjects did not change their sputum or nasal lavage eosinophil count before and after NPT. Subjects with 156 weeks-AIT demonstrated significantly lower levels of sputum and nasal lavage eosinophil count before and after NPT when compared with non-AIT patients ( P < 0.05). Sputum eosinophil counts positively correlated with nasal lavage eosinophil counts at baseline and 6 hours after NPT ( r = 0.719, P = 0.006 and r = 0.823, P < 0.001, respectively) in non-AIT patients. Conclusion Our results show that AIT can attenuate both upper and lower airway immune response to nasal allergen exposure in patients with AR and/or asthma.

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Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

Cited by 29 publications

References 57 publications

Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

Real-life effectiveness of dupilumab in patients with mild to moderate bronchial asthma comorbid with CRSwNP

Effect of Dermatophagoides pteronyssinus Immunotherapy on Upper and Lower Airway Eosinophilic Inflammatory Response to Nasal Allergen Challenge

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