Airway dysfunction in nasal polyposis

a spectrum of asthmatic disease?

P. A. Williamson, S. Vaidyanathan, K. Clearie, M. Barnes, B. J. Lipworth

    Research output: Contribution to journalArticle

    26 Citations (Scopus)

    Abstract

    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 noninflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV1 (P<0.001). For FEF25-75, BHR and eosinophil count were independent predictors (P<0.001 and P = 0.04). Nasal outcomes were not predictors of spirometry.

    Conclusion and Clinical Relevance In CRSwNP there is asymptomatic airway dysfunction suggestive of an asthmatic phenotype. Impairment of lung function is significantly associated with BHR and eosinophilia but not parameters of nasal disease suggesting that severity of airway dysfunction relates to the spectrum of asthma rather than rhinosinusitis. Lower airway dysfunction is common in CRSwNP but does not correlate to the severity of nasal disease. Signs and symptoms of asthma should be sought and treated in CRSwNP.

    Original languageEnglish
    Pages (from-to)1379-1385
    Number of pages7
    JournalClinical and Experimental Allergy
    Volume41
    Issue number10
    DOIs
    Publication statusPublished - Oct 2011

    Keywords

    • Asthma
    • Nasal polyps
    • Sinusitis
    • Exhaled nitric oxide
    • Allergic rhinitis patients
    • Follow-up
    • Early marker
    • Impairment
    • Standardization
    • Methacholine
    • Inflammation
    • Eosinophilia
    • Spirometry

    Cite this

    Williamson, P. A. ; Vaidyanathan, S. ; Clearie, K. ; Barnes, M. ; Lipworth, B. J. / Airway dysfunction in nasal polyposis : a spectrum of asthmatic disease?. In: Clinical and Experimental Allergy. 2011 ; Vol. 41, No. 10. pp. 1379-1385.
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    title = "Airway dysfunction in nasal polyposis: a spectrum of asthmatic disease?",
    abstract = "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 noninflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV1 (P<0.001). For FEF25-75, BHR and eosinophil count were independent predictors (P<0.001 and P = 0.04). Nasal outcomes were not predictors of spirometry.Conclusion and Clinical Relevance In CRSwNP there is asymptomatic airway dysfunction suggestive of an asthmatic phenotype. Impairment of lung function is significantly associated with BHR and eosinophilia but not parameters of nasal disease suggesting that severity of airway dysfunction relates to the spectrum of asthma rather than rhinosinusitis. Lower airway dysfunction is common in CRSwNP but does not correlate to the severity of nasal disease. Signs and symptoms of asthma should be sought and treated in CRSwNP.",
    keywords = "Asthma, Nasal polyps, Sinusitis, Exhaled nitric oxide, Allergic rhinitis patients, Follow-up, Early marker, Impairment, Standardization, Methacholine, Inflammation, Eosinophilia, Spirometry",
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    Airway dysfunction in nasal polyposis : a spectrum of asthmatic disease? / Williamson, P. A.; Vaidyanathan, S.; Clearie, K.; Barnes, M.; Lipworth, B. J.

    In: Clinical and Experimental Allergy, Vol. 41, No. 10, 10.2011, p. 1379-1385.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Airway dysfunction in nasal polyposis

    T2 - a spectrum of asthmatic disease?

    AU - Williamson, P. A.

    AU - Vaidyanathan, S.

    AU - Clearie, K.

    AU - Barnes, M.

    AU - Lipworth, B. J.

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    N2 - 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 noninflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV1 (P<0.001). For FEF25-75, BHR and eosinophil count were independent predictors (P<0.001 and P = 0.04). Nasal outcomes were not predictors of spirometry.Conclusion and Clinical Relevance In CRSwNP there is asymptomatic airway dysfunction suggestive of an asthmatic phenotype. Impairment of lung function is significantly associated with BHR and eosinophilia but not parameters of nasal disease suggesting that severity of airway dysfunction relates to the spectrum of asthma rather than rhinosinusitis. Lower airway dysfunction is common in CRSwNP but does not correlate to the severity of nasal disease. Signs and symptoms of asthma should be sought and treated in CRSwNP.

    AB - 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 noninflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV1 (P<0.001). For FEF25-75, BHR and eosinophil count were independent predictors (P<0.001 and P = 0.04). Nasal outcomes were not predictors of spirometry.Conclusion and Clinical Relevance In CRSwNP there is asymptomatic airway dysfunction suggestive of an asthmatic phenotype. Impairment of lung function is significantly associated with BHR and eosinophilia but not parameters of nasal disease suggesting that severity of airway dysfunction relates to the spectrum of asthma rather than rhinosinusitis. Lower airway dysfunction is common in CRSwNP but does not correlate to the severity of nasal disease. Signs and symptoms of asthma should be sought and treated in CRSwNP.

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    KW - Nasal polyps

    KW - Sinusitis

    KW - Exhaled nitric oxide

    KW - Allergic rhinitis patients

    KW - Follow-up

    KW - Early marker

    KW - Impairment

    KW - Standardization

    KW - Methacholine

    KW - Inflammation

    KW - Eosinophilia

    KW - Spirometry

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    JF - Clinical and Experimental Allergy

    SN - 0954-7894

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