The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity

Abstract

Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.

Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology

“…Nasal airflow may easily be measured by peak nasal inspiratory flow (PNIF) that is an objective measure of airflow and closely correlated with nasal airway resistance. PNIF is simple to obtain, and the devices are inexpensive and can be used for repeated measurements 75 . The EPOS steering group 1 identified as cut offs for severe CRSwNP a VAS > 7, SNOT-22 > 40 and NPS > 5.…”

Outcome measures for chronic rhinosinusitis with nasal polyps

“…Furthermore, other factors associated with nasal obstruction, such as mucosal oedema, inferior turbinate hypertrophy, or anatomical abnormalities, may be present in both phenotypes. This is evident in prior conflicting findings where CRSwNP was found to have worse (275) , similar (276,277) or even better (278) PNIF measurements compared to CRSsNP.…”

“…A moderate correlation between PNIF and VAS scores for nasal obstruction has also been reported among patients with CRSwNP (r=-0.48, p<0.01) (248) , with a weak inverse correlation between PNIF and the SNOT-22 blockage score (r=-0.40, p<0.01) (248) and total score (r=0.4,p<0.05) (280) . The validity of PNIF has further been shown by demonstrating correlation between it and other objective measures of nasal obstruction (such as acoustic rhinometry and rhinomanometry) (269,275) . PNIF has been found…”

Systematic review of measures of disease severity in rhinitis

“…Although these PROMs have widespread clinical application, physiologic clinical metrics help clinicians to better understand precise anatomic and physiologic impact of AR and may aid in providing better prognostic information. 8 Unfortunately, there is still poor consensus in regard to how well PROMs correspond with physiologic measurements, such as peak nasal inspiratory flow (PNIF) and nasal airflow. 9,10 The goal of this study is to determine if measures of disease burden, specifically PROMs and clinical physiologic measures, vary based upon historical and more recent classification of rhinitis, as well as factors associated with these measures to better understand the impact of rhinitis upon our patients.…”