United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis

Abstract

The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.

Nitric Oxide: A Promising Methodological Approach in Airway Diseases

“…These apparently controversial results are explained due to the blockade of the ostiomeatal complex, and to the consequent inability of newly generated NO to reach the nasal cavity. Actually, an inverse correlation between nasal NO levels and the extent of sinus disease and the number of occluded paranasal sinuses has been reported [71,75,76]. The hypothesis of occluded sinus ostia was supported by the fact that after medical [75,77] and surgical [75] treatment of nasal polyps, nasal NO levels were significantly elevated.…”

“…Hence, it would seem likely that higher epithelial iNOS levels in nasal polyposis would be associated with higher nasal NO levels by upregulation. However, interestingly in these patients, nasal NO levels were lower compared to controls or to individuals with uncomplicated allergic rhinitis [70,71,72,73] and exhaled NO was increased, even in non-atopic patients [72,74]. In patients with bronchiectasis, nasal NO was lower in CRS with nasal polyposis than in CRS without nasal polyposis, and inversely correlated with the occupancy of the ostiomeatal complex by CT scans in patients with nasal polyps [71].…”

“…However, interestingly in these patients, nasal NO levels were lower compared to controls or to individuals with uncomplicated allergic rhinitis [70,71,72,73] and exhaled NO was increased, even in non-atopic patients [72,74]. In patients with bronchiectasis, nasal NO was lower in CRS with nasal polyposis than in CRS without nasal polyposis, and inversely correlated with the occupancy of the ostiomeatal complex by CT scans in patients with nasal polyps [71]. These apparently controversial results are explained due to the blockade of the ostiomeatal complex, and to the consequent inability of newly generated NO to reach the nasal cavity.…”

The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma

“…Yet it was found that in patients with asthma, the prevalence of nasal symptoms and CRS was 85% to 95% 3. Furthermore, recent studies showed that patients with chronic obstructive pulmonary disease (COPD), nonallergic asthma, or bronchiectasis had increased nasal symptoms and more nasal inflammation 9–11. Associations between upper and lower airway inflammatory diseases, asthma development, and other lung diseases are not fully understood.…”

Airways disease: just nosing around?

“…Effective mucociliary clearance is vital for respiratory health, as evidenced by the effects of defects such as primary ciliary dyskinesia (PCD) and cystic fibrosis. Sinus disease is almost universal in these patients, and even the subgroup of idiopathic bronchiectasis demonstrates high rates of chronic sinus infection, polyps and inflammation 2. Simple measures such as nasal douching can help with symptoms and quality of life.…”