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O'Connell D, Bouazza B, Kokalari B, Amrani Y, Khatib A, Ganther JD, Tliba O. IFN-γ-induced JAK/STAT, but not NF-κB, signaling pathway is insensitive to glucocorticoid in airway epithelial cells. Am J Physiol Lung Cell Mol Physiol 2015; 309:L348-59. [PMID: 26092996 PMCID: PMC4538237 DOI: 10.1152/ajplung.00099.2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/12/2015] [Indexed: 12/14/2022] Open
Abstract
Although the majority of patients with asthma are well controlled by inhaled glucocorticoids (GCs), patients with severe asthma are poorly responsive to GCs. This latter group is responsible for a disproportionate share of health care costs associated with asthma. Recent studies in immune cells have incriminated interferon-γ (IFN-γ) as a possible trigger of GC insensitivity in severe asthma; however, little is known about the role of IFN-γ in modulating GC effects in other clinically relevant nonimmune cells, such as airway epithelial cells. We hypothesized that IFN-γ-induced JAK/STAT-associated signaling pathways in airway epithelial cells are insensitive to GCs and that strategies aimed at inhibiting JAK/STAT pathways can restore steroid responsiveness. Using Western blot analysis we found that all steps of the IFN-γ-induced JAK/STAT signaling pathway were indeed GC insensitive. Transfection of cells with reporter plasmid showed IFN-γ-induced STAT1-dependent gene transcription to be also GC insensitive. Interestingly, real-time PCR analysis showed that IFN-γ-inducible genes (IIGs) were differentially affected by GC, with CXCL10 being GC sensitive and CXCL11 and IFIT2 being GC insensitive. Further investigation showed that the differential sensitivity of IIGs to GC was due to their variable dependency to JAK/STAT vs. NF-κB signaling pathways with GC-sensitive IIGs being more NF-κB dependent and GC-insensitive IIGs being more JAK/STAT dependent. Importantly, transfection of cells with siRNA-STAT1 was able to restore steroid responsiveness of GC-insensitive IIGs. Taken together, our results show the insensitivity of IFN-γ-induced JAK/STAT signaling pathways to GC effects in epithelial cells and also suggest that targeting STAT1 could restore GC responsiveness in patients with severe asthma.
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Affiliation(s)
- Danielle O'Connell
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
| | - Belaid Bouazza
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
| | - Blerina Kokalari
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
| | - Yassine Amrani
- Institute for Lung Health, Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, United Kingdom
| | - Alaa Khatib
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
| | - John David Ganther
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
| | - Omar Tliba
- Department of Pharmaceutical Sciences, Thomas Jefferson University, Jefferson School of Pharmacy, Philadelphia, Pennsylvania; and
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Miłkowska-Dymanowska J, Białas AJ, Zalewska-Janowska A, Górski P, Piotrowski WJ. Underrecognized comorbidities of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015. [PMID: 26203239 PMCID: PMC4507790 DOI: 10.2147/copd.s82420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
COPD is associated with different comorbid diseases, and their frequency increases with age. Comorbidities severely impact costs of health care, intensity of symptoms, quality of life and, most importantly, may contribute to life span shortening. Some comorbidities are well acknowledged and established in doctors’ awareness. However, both everyday practice and literature searches provide evidence of other, less recognized diseases, which are frequently associated with COPD. We call them underrecognized comorbidities, and the reason why this is so may be related to their relatively low clinical significance, inefficient literature data, or data ambiguity. In this review, we describe rhinosinusitis, skin abnormalities, eye diseases, different endocrinological disorders, and gastroesophageal reflux disease. Possible links to COPD pathogenesis have been discussed, if the data were available.
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Affiliation(s)
- Joanna Miłkowska-Dymanowska
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Adam J Białas
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Anna Zalewska-Janowska
- Unit of Psychodermatology, Chair of Clinical Immunology and Microbiology, Medical University of Lodz, Łódź, Poland
| | - Paweł Górski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Wojciech J Piotrowski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
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United Airway Diseases. Should We Add Upper Airway Inflammatory Disorders to the List of Chronic Obstructive Pulmonary Disease Comorbidities? Ann Am Thorac Soc 2015. [DOI: 10.1513/annalsats.201505-309ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Celakovsky P, Smatanova K, Kalfert D, Pracharova S, Koblizek V. Nasal symptomatology, obstruction, and paranasal sinus opacity in patients with chronic obstructive pulmonary disease. Acta Otolaryngol 2015; 135:598-601. [PMID: 25677759 DOI: 10.3109/00016489.2014.999876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Patients with chronic obstructive pulmonary disease (COPD) more frequently suffer from nasal symptoms as well as upper respiratory tract obstruction compared with the healthy population. OBJECTIVE The relationship between chronic rhinosinusitis and bronchial asthma has been studied in detail in the past. In recent years, a limited number of authors have also studied involvement of the nose and paranasal sinuses in patients with COPD. METHODS This was an observational cross-sectional study with subsequent prospective assessment; 42 patients with COPD were included. The control group consisted of 12 healthy subjects. All patients with a history of rhinitis or rhinosinusitis and patients with previous surgery of the nose and sinuses were excluded from the study. Clinical variables evaluated were nasal symptoms (SNAQ-11 questionnaire), nasal endoscopy, nasal patency (active rhinomanometry), and computed tomography of paranasal sinuses. RESULTS In the COPD group, there was a higher occurrence of nasal symptoms and pathological findings on nasal endoscopy compared with the control group. The overall nasal airflow was higher in the control group (compared with COPD patients) and the overall nasal resistance was higher in the COPD group (compared with controls). Pathological opacity of one or more sinuses was confirmed in 38% of COPD patients.
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Kariya S, Okano M, Nishizaki K. Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review. World J Otorhinolaryngol 2015; 5:44-52. [DOI: 10.5319/wjo.v5.i2.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.
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56
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Srivastava K, Thakur D, Sharma S, Punekar YS. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PHARMACOECONOMICS 2015; 33:467-488. [PMID: 25663178 DOI: 10.1007/s40273-015-0252-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An understanding of the humanistic and economic burden of individuals with symptomatic chronic obstructive pulmonary disease (COPD) is required to inform payers and healthcare professionals about the disease burden. OBJECTIVES The aim of this systematic review was to identify and present humanistic [health-related quality of life (HRQoL)] and economic burdens of symptomatic COPD. METHODS A comprehensive search of online databases (reimbursement or claims databases/other databases), abstracts from conference proceedings, published literature, clinical trials, medical records, health ministries, financial reports, registries, and other sources was conducted. Adult patients of any race or gender with symptomatic COPD were included. Humanistic and economic burdens included studies evaluating HRQoL and cost and resource use, respectively, associated with symptomatic COPD. RESULTS Thirty-two studies reporting humanistic burden and 74 economic studies were identified. Symptomatic COPD led to impairment in the health state of patients, as assessed by HRQoL instruments. It was also associated with high economic burden across all countries. The overall, direct, and indirect costs per patient increased with an increase in symptoms, dyspnoea severity, and duration of disease. Across countries, the annual societal costs associated with symptomatic COPD were higher among patients with comorbidities. CONCLUSIONS Symptomatic COPD is associated with a substantial economic burden. The HRQoL of patients with symptomatic COPD is, in general, low and influenced by dyspnoea.
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Affiliation(s)
- Kunal Srivastava
- HERON Health PVT (Now Parexel), 3rd Floor, DLF Tower E, Rajiv Gandhi IT Park, Chandigarh, India
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Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, Peters AT, Rondon C, Togias A, Cox LS. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy 2015; 70:474-94. [PMID: 25620381 DOI: 10.1111/all.12573] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 12/29/2022]
Abstract
Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiology, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear-cut definitions difficult. Nevertheless, a phenotype-/endotype-based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhinitis diagnosis and management approaches focusing on those phenotypes/endotypes are presented and discussed. We emphasize the concept of control-based management, which transcends all rhinitis subtypes.
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Affiliation(s)
- N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece
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Chien CY, Tai SY, Wang LF, Lee CTC. Chronic Obstructive Pulmonary Disease Predicts Chronic Rhinosinusitis without Nasal Polyps: A Population-Based Study. Am J Rhinol Allergy 2015; 29:e75-80. [DOI: 10.2500/ajra.2015.29.4172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and chronic rhinosinusitis without nasal polyps (CRSsNP) outcomes. The aim of this study was to investigate the association between COPD and the risk of CRSsNP in a large national sample. Methods Patients 15 years or older with a new primary diagnosis of COPD (International Classification of Diseases, Ninth edition [ICD-9], 491, 492, 494, and 496) between 2000 and 2007 were identified from the National Health Insurance Research Database of Taiwan. The patients were compared with sex-, age-, residence-, and insurance premium–matched controls, and both groups were followed up until the end of 2008 for instances of CRSsNP, defined as ICD-9 codes CRS (473, 473.0, 473.1, 473.2, 473.3, 473.8, and 473.9), excluding NP (471, 471.0, 471.1, 471.8, and 471.9). Competing risk-adjusted Cox regression analyses were applied after adjusting for sex, age, residence, insurance premium, steroid use (topical or systemic), hyperlipidemia, diabetes, hypertension, coronary artery disease, hospital admission days, and mortality. Results We included 34,029 cases and 34,029 matched controls in this study. Among the 68,058 subjects, 569 developed CRSsNP during a mean (standard deviation [SD]) follow-up period of 5.0 years (SD 2.2 years). COPD was an independent predictor of CRSsNP in the fully adjusted model (hazard ratio = 3.24; 95% CI = 2.65-3.96; p < 0.01). Conclusion COPD was associated with an increased risk of CRSsNP in this study population, independent of a number of potential confounding factors.
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Affiliation(s)
- Chen-Yu Chien
- Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Shu-Yu Tai
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ling-Feng Wang
- Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Charles Tzu-Chi Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Möller W, Schuschnig U, Bartenstein P, Meyer G, Häussinger K, Schmid O, Becker S. Drug delivery to paranasal sinuses using pulsating aerosols. J Aerosol Med Pulm Drug Deliv 2015; 27:255-63. [PMID: 25084017 DOI: 10.1089/jamp.2013.1071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is the major disorder of the upper airways, affecting about 10-15% of the total population. Topical treatment regimens show only modest efficacy, because drug delivery to the posterior nose and paranasal sinuses is still a challenge. Therefore, there is a high rate of functional endoscopic sinus surgery in CRS patients. Most nasally administered aerosolized drugs, like nasal pump sprays, are efficiently filtered by the nasal valve and do not reach the posterior nasal cavity and the sinuses, which are poorly ventilated. However, as highlighted in this review, sinus ventilation and paranasal aerosol delivery can be achieved by using pulsating airflow, offering new topical treatment options for nasal disorders. Radioaerosol inhalation and imaging studies in nasal casts and in healthy volunteers have shown 4-6% of the nasally administered dose within the sinuses. In CRS patients, significant aerosol deposition in the sinus cavities was reported before sinus surgery. After surgery, deposition increased to the amount observed in healthy volunteers. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposited in the nasal cavity was prolonged, both in healthy volunteers and in CRS patients. These efficiencies may be sufficient for topical aerosol therapies of sinus disorders and, due to the prolonged retention kinetics, may reduce application modes, but have to be proven in future clinical trials. Pulsating aerosols may offer additional new topical treatment options of nasal and sinus disorders before as well as after surgery.
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Affiliation(s)
- Winfried Möller
- 1 Comprehensive Pneumology Center, Institute for Lung Biology and Disease , Helmholtz Zentrum München, Neuherberg, Germany
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Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, Jirapongsananuruk O, Kern R, Meltzer EO, Mullol J, Naclerio R, Pilan R, Rhee CS, Suzaki H, Voegels R, Blaiss M. ICON: chronic rhinosinusitis. World Allergy Organ J 2014; 7:25. [PMID: 25379119 PMCID: PMC4213581 DOI: 10.1186/1939-4551-7-25] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 02/06/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory (URL), University Hospital Ghent, Kragujevac, Belgium
| | - Ruby Pawankar
- Div. of Allergy, Dept. of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Luo Zhang
- Beijing Key Laboratory of Nasal diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Chaweewan Bunnag
- Faculty of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Daniel L Hamilos
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, MA USA
| | | | - Robert Kern
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Eli O Meltzer
- Allergy & Asthma Medical Group & Research Center, San Diego, California USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Hospital Clínic - IDIBAPS, Barcelona, Catalonia Spain
| | - Robert Naclerio
- Section of Otolaryngology Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois USA
| | - Renata Pilan
- Department of Otorhinolaryngology, Clinics Hospital/University of Sao Paulo Medical School, Kragujevac, Brazil
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, Korea
| | - Harumi Suzaki
- Dept. of Otorhinolaryngology, Showa University, Tokyo, Japan
| | - Richard Voegels
- Department of Rhinology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Michael Blaiss
- University of Tennessee Health Science Center, Memphis, Tennessee
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Kariya S, Okano M, Higaki T, Noyama Y, Haruna T, Ishihara H, Makino T, Onoda T, Nishizaki K. Chronic rhinosinusitis patients have decreased lung function. Int Forum Allergy Rhinol 2014; 4:828-33. [PMID: 25132678 DOI: 10.1002/alr.21370] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The relationship between upper and lower airway diseases has been reported. However, the pulmonary function of patients with chronic rhinosinusitis (CRS) has not been fully examined. METHODS Pulmonary function was measured in 273 patients with CRS and 100 age-matched normal control subjects. No patients with chronic obstructive pulmonary disease (COPD) were included in this study. The patients with CRS were divided into 8 subgroups based on the presence of asthma, sensitization to common inhaled antigens, and nasal polyposis. The relationships between pulmonary function and clinical parameters, including radiographic severity of CRS according to the Lund-Mackay computed tomography (CT) staging system, eosinophil count in the peripheral blood, and serum total immunoglobulin E (IgE) levels, were assessed. RESULTS In pulmonary function testing, the CRS patients had affected pulmonary function. The CRS patients without asthma showed latent obstructive pulmonary function changes when compared to normal controls. No significant correlations were observed between pulmonary function and any clinical parameters (Lund-Mackay CT staging score, eosinophil count in the peripheral blood, and serum total IgE levels). CONCLUSION CRS patients had significant obstructive lung function changes regardless of the presence of asthma. The patients with CRS who had not been clinically diagnosed as having lower respiratory tract diseases might have had subclinical lower airway diseases. Therefore, clinicians should be aware of pulmonary function and lower lung diseases in patients with CRS.
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Affiliation(s)
- Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Pite H, Pereira AM, Morais-Almeida M, Nunes C, Bousquet J, Fonseca JA. Prevalence of asthma and its association with rhinitis in the elderly. Respir Med 2014; 108:1117-26. [PMID: 24877896 DOI: 10.1016/j.rmed.2014.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma and rhinitis are frequent respiratory diseases in children and adults. Despite the increase in the aging population, there are few epidemiologic data on both diseases in the elderly. So far, no population-based study has analyzed the association between asthma and rhinitis symptoms and severity in this age group. This study aimed to estimate the prevalence of physician-diagnosed asthma in the population aged ≥65 years in mainland Portugal and to evaluate its association with the presence and classification of rhinitis according to ARIA recommendations, in this age group. METHODS A cross-sectional, nationwide, population-based survey of individuals aged ≥65 years, living in mainland Portugal was performed. RESULTS Data were obtained from 3678 respondents. The prevalence of physician-diagnosed asthma was 10.9% (95% confidence interval (95%CI) 9.9-11.9). The frequency of asthma diagnosis increased with the number of nasal symptoms (p < 0.001). A strong association between asthma and rhinitis was found (odds ratio (OR) 13.86 (95%CI 10.66-18.02)). The strength of this association increased with the persistence and severity of rhinitis, being particularly high in elderly subjects with moderate-severe persistent rhinitis (OR 39.9 (95%CI 27.5-58.0)). CONCLUSIONS Asthma is common in the elderly and strongly associated with rhinitis. The OR for asthma is especially high in persistent and severe ARIA classification rhinitis types. This study strengthens the need for an integrated assessment of asthma together with rhinitis in the elderly.
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Affiliation(s)
- H Pite
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; CEDOC, Faculty of Medical Sciences, Pharmacology Department, Lisbon, Portugal.
| | - A M Pereira
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Hospital S. João EPE, Allergy and Clinical Immunology Department, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Health Information and Decision Sciences Department, Porto, Portugal; Instituto e Hospital CUF Porto, Allergy Unit, Porto, Portugal
| | - M Morais-Almeida
- Hospital CUF-Descobertas and Hospital CUF-Infante Santo, Immunoallergy Department, Lisbon, Portugal; Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - C Nunes
- Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
| | - J A Fonseca
- Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Portugal; Hospital S. João EPE, Allergy and Clinical Immunology Department, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Health Information and Decision Sciences Department, Porto, Portugal; Instituto e Hospital CUF Porto, Allergy Unit, Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
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Lee SY, Yoon SH, Song WJ, Lee SH, Kang HR, Kim SS, Cho SH. Influence of chronic sinusitis and nasal polyp on the lower airway of subjects without lower airway diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:310-5. [PMID: 24991454 PMCID: PMC4077957 DOI: 10.4168/aair.2014.6.4.310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/04/2013] [Accepted: 09/12/2013] [Indexed: 11/25/2022]
Abstract
Purpose Upper and lower respiratory tract pathologies are believed to be interrelated; however, the impact of upper airway inflammation on lung function in subjects without lung disease has not been evaluated. This study investigated the association of CT finding suggesting chronic sinusitis and lung function in healthy subjects without lung disease. Methods This was a retrospective study of prospectively collected data from 284 subjects who underwent a pulmonary function test, bronchial provocation test, rhinoscopy, and osteomeatal unit computed tomography offered as a private health check-up option. Results CT findings showed that the sinusitis group had a significantly lower FEV1/FVC ratio than subjects without sinusitis finding (78.62% vs 84.19%, P=0.019). Among the sinusitis group, subjects classified by CT findings as the extensive disease group had a slightly lower FEV1/FVC than those of the limited disease group (76.6% vs 79.5%, P=0.014) and the associations were independent of the presence of airway hyperresponsiveness. The subjects with nasal polyp had also lower FEV1 and FEV1/FVC than subjects without nasal polyp (FEV1: 100.0% vs 103.6%, P=0.045, FEV1/FVC: 77.4% vs 80.0%, P=0.005). Conclusions CT findings suggesting chronic sinusitis and nasal polyp were associated with subclinical lower airway flow limitation even in the absence of underlying lung disease.
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Affiliation(s)
- Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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64
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Chang CC, Incaudo GA, Gershwin ME. Sinusitis, Rhinitis, Asthma, and the Single Airway Hypothesis. DISEASES OF THE SINUSES 2014. [PMCID: PMC7121820 DOI: 10.1007/978-1-4939-0265-1_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The one airway, one disease hypothesis proposes that the upper and lower airways share the same physiology and histomorphology. Epidemiological clinical studies support a link between rhinosinusitis and asthma. The relationship can occur in both directions, with nasal allergen challenge leading to inflammatory changes in the lower airway and bronchoprovocation studies of the lower airway leading to inflammatory changes in the upper airway. In addition, both similarities and differences exist in the pathogenesis of nasal polyps and asthma. The mechanism for the connection between the upper and lower airways is a matter of great debate. It has been proposed that inflammatory changes in the lower airway may lead to systemic inflammatory effects that play a role in increased bronchial hyperresponsiveness. Similarly, lower airway inflammatory changes may affect nasal airway patency via systemic effects. Moreover, nasopharyngeal-bronchial reflexes may play a non-immunologic role in the interaction between the lower and upper airways. An example of the connection between the upper and lower airways is found in aspirin-exacerbated respiratory disease whereby leukotrienes play a role in the pathology of chronic rhinosinusitis with polyps and asthma. It is also been observed that the treatment of asthma is hindered by untreated rhinosinusitis.
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Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
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Abstract
PURPOSE OF REVIEW Basic science studies directed at understanding the inflammatory mechanisms in chronic rhinosinusitis (CRS) are increasing, yet their relevance to the underlying disease process is often conflicting and confounded by the enrollment of a heterogeneous CRS population. This review is aimed at exploring the issues affecting the basic science mucosal studies of CRS patients, with special attention to the inclusion criteria for CRS and the control group, and the site from which the mucosal tissue sample is obtained. RECENT FINDINGS A common confounding factor is an inadequate documentation of selection criteria for patients, controls, and tissue sites examined. Inconsistent definitions for CRS and for maximum medical therapy, and a lack of histopathology confirmation of mucosal inflammation (eosinophilic or neutrophilic) can bias the disease population entering a given study. Further confounding factors include the influence of coexisting diseases, pollution and cigarette smoke, and a need for same-site tissue comparisons, meticulous selection of relevant controls, and consensus on 'nondiseased' mucosal inflammatory cell populations and microbiology. SUMMARY Documentation of well defined patient and control groups, standardized specimen collection methods, and detection assays are critical in minimizing the bias and conflicting findings among investigators. With standardized sampling of tissue sites and tight controls on subcategories of CRS patients enrolled, studies will more likely identify the findings that can increase our understanding of the disparate group of CRS patients and identify new therapeutic targets in the CRS subcategories.
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66
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Caillaud D, Chanez P, Escamilla R, Burgel PR, Court-Fortune I, Nesme-Meyer P, Deslee G, Perez T, Pinet C, Roche N. Association of chronic nasal symptoms with dyspnoea and quality-of-life impairment in chronic obstructive pulmonary disease. Respirology 2013; 19:346-52. [PMID: 24330257 DOI: 10.1111/resp.12224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/25/2013] [Accepted: 10/06/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Previous studies suggested that chronic nasal symptoms (CNS) are frequent in chronic obstructive pulmonary disease (COPD) subjects, but their contribution to dyspnoea and quality-of-life (QoL) impairment is not clearly established. METHODS Data from the French COPD cohort 'Initiatives bronchopneumopathie chronique obstructive' were analyzed to assess the frequency of CNS (rhinorrhea, obstruction, anosmia) in COPD patients and analyze their impact and associated risk factors. Univariate and multivariate analyses were performed to assess the relationship between CNS with sociodemographic and anthropometric characteristics, risk factors, respiratory symptoms, spirometry, QoL (Saint George's respiratory questionnaire (SGRQ)), dyspnoea (modified Medical Research Council (mMRC) scale), mood disorders (Hospital Anxiety and Depression Scale (HADS)), number of exacerbations and comorbid conditions. RESULTS CNS were reported by 115 of 274 COPD subjects (42%). Among them, rhinorrhea and nasal obstruction were reported by 62% and 43%, respectively. In multivariate analysis, COPD patients with CNS had higher SGRQ total scores, corresponding to worse QoL (P = 0.01), while no independent association was found with exacerbations, lung function and HADS. Among SGRQ domains, an independent association was found with the activity score (P = 0.007). When SGRQ score was forced out of the model to avoid redundancy, mMRC score was independently associated with CNS (P = 0.01). Among risk factors, cumulative smoking, hay fever and atopic dermatitis but not occupational exposures were independently associated with CNS. CONCLUSIONS In this group of COPD subjects, CNS were frequently observed and associated with dyspnoea and poorer QoL. CNS should be systematically assessed and could be a potential target in the management of COPD.
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Affiliation(s)
- Denis Caillaud
- Pulmonary Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
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67
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Ussavarungsi K, Limsuwat C, Berdine G, Nugent K. Is the sinonasal questionnaire a useful screening instrument for chronic sinonasal diseases in pulmonary clinics? Chron Respir Dis 2013; 10:95-8. [PMID: 23620440 DOI: 10.1177/1479972313485457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Dixon and coworkers (Dixon AE, Sugar EA, Zinreich SJ, et al. Criteria to screen for chronic sinonasal disease. Chest 2009; 136: 1324-1332.) recently developed a five-item questionnaire for diagnosing chronic sinonasal disease in patients with asthma. Our study was designed to determine how frequently patients attending pulmonary clinics have chronic sinonasal disease and the relationship between questionnaire results and a history of sinus disease and current treatment for sinus disease. The participants were patients in pulmonary clinics at Texas Tech University Health Science Center, who answered the sinonasal questionnaire (SNQ). Additional information included a history of sinus disease or sinus/nasal surgery, smoking status, and current relevant medications. The participants included 28 men and 51 women. Patient ages ranged from 38 to 94 years (mean 62.2 years). Of all the patients, 28 patients (35.4%) had prior sinus disease, 10 (12.7%) had history of sinus or nasal surgery, 24 (30.4%) had history of asthma, and 10 (12.7%) were current smokers. Of them, 14 patients (17.7%) used nasal steroids, 12 (15.2%) used antihistamines, four (5.1%) used decongestants, nine (11.4%) used leukotriene inhibitors, 13 (16.5%) used oral corticosteroids, and two (2.5%) used combinations. The SNQ identified 39 patients (49.4%) as having chronic sinonasal diseases. Therefore, 14% of the participants had sinonasal symptoms but no prior diagnosis of sinus disease. Patients with prior sinus disease and nasal steroid use were more likely to have positive questionnaire result (p<0.001 and p<0.032, respectively). The SNQ can identify patients with chronic sinonasal disease in pulmonary clinics. However, the significance of sinonasal disease and its treatment in these patients needs more study.
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Affiliation(s)
- Kamonpun Ussavarungsi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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68
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Ek A, Middelveld RJM, Bertilsson H, Bjerg A, Ekerljung L, Malinovschi A, Stjärne P, Larsson K, Dahlén SE, Janson C. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy 2013; 68:1314-21. [PMID: 24107218 DOI: 10.1111/all.12222] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. METHODS This Swedish cohort (age 17-76 years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2) LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. RESULTS Subjects having both asthma and CRS have lower mAQLQ scores in all domains (P < 0.001) and a lower EQ-5D index value and EQ-5D VAS value (P < 0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P < 0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P < 0.0001), lower lung function (P = 0.008), current smoking (P = 0.01), BMI > 30 kg/m2 (P = 0.04), high age (P = 0.03), and a negative SPT (P = 0.04). CONCLUSIONS Comorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.
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Affiliation(s)
- A. Ek
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - R. J. M. Middelveld
- The Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - H. Bertilsson
- Department of Public Health and Clinical Medicine: Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | - A. Bjerg
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - L. Ekerljung
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - A. Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
| | - P. Stjärne
- Department of Clinical Science; Intervention and Technology: Otorhinolaryngology; Karolinska Institutet; Stockholm; Sweden
| | - K. Larsson
- Lung and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - S.-E. Dahlén
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
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69
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Thorstensen WM, Sue-Chu M, Bugten V, Steinsvåg SK. Nasal flow, volumes, and minimal cross sectional areas in asthmatics. Respir Med 2013; 107:1515-20. [PMID: 23953957 DOI: 10.1016/j.rmed.2013.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/18/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Unified Airways hypothesis suggests an involvement of the upper airways in asthma. Critical parameters of the nasal airway can be quantified objectively with acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF). OBJECTIVE We aimed to investigate nasal airway patency in asthmatics compared to non-asthmatic controls. Nasal volume, cross sectional area and flow were measured using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in 87 asthmatics and 93 non-asthmatic controls before and after decongestion with xylometazoline. Nasal congestion index (NCI) was calculated, and allergy status was assessed by skin prick test or specific IgE. RESULTS We found significantly smaller minimum cross sectional area and nasal cavity volume in asthmatics than controls, and the cross sectional area is at its minimum at 2-3 cm from the nasal orifice in both groups. AR and PNIF measurements are not different in allergic and non allergic subjects in either group. The effect of xylometazoline is not significantly different between the 2 groups with regard to AR, but there is a significant improvement in PNIF for the asthmatics when assessed by the NCI. CONCLUSION The present study demonstrates a significantly smaller nasal airway when assessed by minimum cross sectional area and nasal cavity volume in asthmatics than controls, and these findings apply to asthmatics and controls irrespective of allergy status.
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Affiliation(s)
- Wenche Moe Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, 7006 Trondheim, Norway; Institute of Neuroscience, Norwegian University of Science and Technology, 7006 Trondheim, Norway.
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70
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Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score. The Journal of Laryngology & Otology 2013; 127 Suppl 2:S24-8. [PMID: 23544818 DOI: 10.1017/s0022215113000558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis. STUDY DESIGN A prospective cohort study supplying level 2b evidence. METHODS Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund-Mackay computed tomography scores and Lund-Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation. RESULTS Mean scores (95 per cent confidence intervals) were 22.31 (21.47-24.15) for the Adelaide Disease Severity Score and 30.6 (27.15-34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund-Mackay score (p = 0.04) and with the Lund-Kennedy score (p = 0.03). CONCLUSION The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund-Mackay and Lund-Kennedy tools.
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71
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Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, Dietz de Loos D, Gevaert P, Hox V, Kalogjera L, Lund V, Mullol J, Papadopoulos NG, Passalacqua G, Rondón C, Scadding G, Timmermans M, Toskala E, Zhang N, Bousquet J. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy 2013; 68:1-7. [PMID: 23025484 DOI: 10.1111/all.12040] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 01/15/2023]
Abstract
State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment. This group with so-called severe chronic upper airway disease (SCUAD) represents a therapeutic challenge. The concept of control of disease has only recently been introduced in the field of AR and CRS. In case of poor control of symptoms despite guideline-directed pharmacotherapy, one needs to consider the presence of SCUAD but also treatment-related, diagnosis-related and/or patient-related factors. Treatment-related issues of uncontrolled upper airway disease are linked with the correct choice of treatment and route of administration, symptom-oriented treatment and the evaluation of the need for immunotherapy in allergic patients. The diagnosis of AR and CRS should be reconsidered in case of uncontrolled disease, excluding concomitant anatomic nasal deformities, global airway dysfunction and systemic diseases. Patient-related issues responsible for the lack of control in chronic upper airway inflammation are often but not always linked with adherence to the prescribed medication and education. This review is an initiative taken by the ENT section of the EAACI in conjunction with ARIA and EPOS experts who felt the need to provide a comprehensive overview of the current state of the art of control in upper airway inflammation and stressing the unmet needs in this domain.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; The Netherlands
| | - C. Akdis
- Swiss Intitute of Allergy; Davos; Switzerland
| | - C. Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - C. Cingi
- Department of Otorhinolaryngology-Head and Neck Surgery; Osmangazi University; Eskilehir; Turkey
| | - D. Dietz de Loos
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; The Netherlands
| | - P. Gevaert
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - V. Hox
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - L. Kalogjera
- University Department of ENT; Head and Neck Surgery; Sestre Milosrdnice University Hospital Center; Zagreb; Croatia
| | - V. Lund
- Royal National Throat, Nose and Ear Hospital; University College; London; UK
| | - J. Mullol
- Rhinology Unit and Smell Clinic; Department of Otorhinolaryngology; Hospital Clinic; Athens; Greece
| | - N. G. Papadopoulos
- Department of Allergy; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | - G. Passalacqua
- Allergy and Respiratory Diseases; Department of Internal Medicine; University of Genoa; Genoa; Italy
| | - C. Rondón
- IDIBAPS; CIBERES; Barcelona; Catalonia; Spain
| | - G. Scadding
- Royal National Throat, Nose and Ear Hospital; University College; London; UK
| | - M. Timmermans
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - E. Toskala
- Center for Applied Genomics; Children's Hospital Philadelphia; Philadelphia; PA; USA
| | - N. Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - J. Bousquet
- Department of Respiratory Disease; University Hospital Arnaud de Villeneuve; Montpellier; France
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Southworth T, Metryka A, Lea S, Farrow S, Plumb J, Singh D. IFN-γ synergistically enhances LPS signalling in alveolar macrophages from COPD patients and controls by corticosteroid-resistant STAT1 activation. Br J Pharmacol 2012; 166:2070-83. [PMID: 22352763 DOI: 10.1111/j.1476-5381.2012.01907.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE IFN-γ levels are increased in chronic obstructive airway disease (COPD) patients compared with healthy subjects and are further elevated during viral exacerbations. IFN-γ can 'prime' macrophages to enhance the response to toll-like receptor (TLR) ligands, such as LPS. The aim of this study was to examine the effect IFN-γ on corticosteroid sensitivity in alveolar macrophages (AM). EXPERIMENTAL APPROACH AM from non-smokers, smokers and COPD patients were stimulated with IFN-γ and/or LPS with or without dexamethasone. IL-6, TNF-α and IFN-γ-induced protein 10 kDa (IP-10) levels were measured by elisa, and Western blots were used to investigate the IFN-γ-stimulated Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling pathway. Real-time PCR and flow cytometry were used to investigate TLR levels following IFN-γ treatment. KEY RESULTS In all three subject groups, IFN-γ alone had no effect on IL-6 and TNF-α production but enhanced the effects of LPS on these cytokines. In contrast, IFN-γ alone increased the production of IP-10. IFN-γ increased TLR2 and TLR4 expression in AM. Cytokine induction and STAT1 activation by IFN-γ were insensitive to dexamethasone for all groups. The inhibition of JAK and STAT1 repressed all these IFN-γ effects. CONCLUSIONS AND IMPLICATIONS Our results demonstrate that IFN-γ-induced STAT-1 signalling is corticosteroid resistant in AMs, and that targeting IFN-γ signalling by JAK inhibitors is a potentially novel anti-inflammatory strategy in COPD.
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Affiliation(s)
- T Southworth
- Manchester Academic Health Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Manchester, UK.
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Picavet VA, Grietens J, Jorissen M, Hellings PW. Rhinoplasty from a rhinologist's perspective: need for recognition of associated sinonasal conditions. Am J Rhinol Allergy 2012; 26:493-6. [PMID: 23232202 PMCID: PMC3903105 DOI: 10.2500/ajra.2012.26.3816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Facial plastic surgeons may primarily focus on esthetic improvement of the nasal shape in patients seeking rhinoplasty (RP). However, medical conditions inside the nasal cavity should not be neglected because they may lead to unresolved sinonasal problems and, hence, dissatisfaction after esthetic RP. This observational study investigated the prevalence of sinonasal symptoms and endonasal pathology in patients requesting esthetic RP. METHODS Patients seeking RP (n = 269) were given a questionnaire evaluating nasal obstruction and sinonasal symptoms using visual analog scales and the 22-item Sino-Nasal Outcome Test. In addition, patients underwent nasal endoscopy to evaluate anatomic and/or mucosal disease and skin-prick testing in case of clinical suspicion of allergy. Two control groups consisted of patients with an otological or general ear/nose/throat problem (n = 65) and patients who planned for endoscopic sinus surgery (ESS; n = 90). RESULTS The general appraisal of nasal breathing on a scale from 0-10 in patients seeking RP was as low as 4.3 ± 3.1. Structural pathology was found in 62% of RP patients, with septal deviation being the most frequent problem encountered (54%), followed by internal nasal valve dysfunction (14%). Mucosal disease was present in 28% of RP patients. The mean SNOT-22 score of RP patients (31.8 ± 23.3) was significantly higher than the control group (11.6 ± 7.9; p < 0.001), but lower than the ESS patients (48.5 ± 22.0; p < 0.001). CONCLUSION The prevalence of endonasal structural or mucosal pathology in patients seeking RP is high and should not be overlooked at the time of planning surgery.
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Affiliation(s)
- Valerie A Picavet
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium
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Huang Z, Zhou B, Zhang Q, Huang Q, Sun Y, Wang M, Wang X, Wang C, Li Y, Cui S. The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma. Laryngoscope 2012; 123:569-73. [PMID: 23070787 DOI: 10.1002/lary.23649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/25/2012] [Accepted: 07/17/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the role of airway patency and factors associated with airway patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. STUDY DESIGN Retrospective study. METHODS The upper and lower airway patency of 140 patients with CRSwNP and asthma (asthma group) and 42 patients with CRSwNP without asthma (nonasthma control group) was measured using acoustic rhinometry, rhinomanometry, and spirometry. Total serum immunoglobulin E and eosinophil counts were also compared. The severity of nasal diseases in these patients was assessed via the Lund-Mackay score (LMS) and Lund-Kennedy score (LKS). RESULTS There was no difference between the asthma and nonasthma groups in terms of total nasal resistance at 75 Pa (R(75T)), bilateral minimum cross-sectional area (MCA(R+L)), or bilateral nasal cavity volume between 0 and 7.0 cm(3) (V7(R+L)). Forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75)) of the asthma group were significantly lower than those of the nonasthma group. FEV(1) and FEF(25-75) were not correlated with R(75T), MCA(R+L), V7(R+L), or severity of nasal disease. For the patients with asthma, LMS and serum eosinophil counts were independent predictors of MCA(R+L). CONCLUSIONS The presence of asthma may not influence upper airway patency in CRSwNP patients. In CRSwNP patients with asthma, impairment of upper airway patency was associated with changes in LMS and eosinophilia, and in these patients lower airway patency was significantly lower than that of the control group (without asthma). In CRSwNP patients with asthma, there was little or no association between upper and lower airway patency.
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Affiliation(s)
- Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology-Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
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Thorstensen WM, Bugten V, Sue-Chu M, Fossland NPW, Romundstad PR, Steinsvåg SK. Sino-nasal characteristics in asthmatic patients. Otolaryngol Head Neck Surg 2012; 147:950-7. [PMID: 22714421 DOI: 10.1177/0194599812451408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Unified Airways Hypothesis suggests an involvement of the upper airways in asthma. We aimed to evaluate the association between subjective sino-nasal complaints, nasal air flow, and sino-nasal quality of life (QOL) in patients with asthma compared with nonasthmatic subjects. STUDY DESIGN Case-control study. SETTING A tertiary referral center. SUBJECTS AND METHODS Symptoms, quality of life, and nasal airflow were assessed in 91 asthmatics and 95 nonasthmatic controls with Visual Analog Scale (VAS, 0-100), Sino-Nasal Outcome Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Asthma and allergy status were assessed by Asthma Control Questionnaire (ACQ) and skin prick test or specific IgE. RESULTS Asthmatic patients (men/women, 37/54; mean age, 43.7 years; range, 19-64 years) reported significantly more nasal obstruction (mean VAS, 37 mm; SD = 26, 95% CI, 32-43 vs 9 mm, SD = 11, 95% CI, 7-11, P < .001) and lower sino-nasal quality of life (mean SNOT-20, 1.3; SD = 0.8, 95% CI, 1.1-1.5 vs 0.4, SD = 0.5, 95% CI, 0.3-0.5, P < .001) than controls (men/women, 42/53; mean age, 43.8 years; range, 20-65 years). PNIF was significantly lower in asthmatic patients than controls (mean PNIF, 84 l/min; SD = 24, 95% CI, 79-89 vs 100 l/min SD = 24, 95% CI, 95-105, P < .001). CONCLUSION Both allergic and nonallergic asthma were associated with increased sino-nasal symptoms, reduced sino-nasal QOL, and reduced inspiratory nasal air flow compared to controls. This provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthma patients beyond the scope of allergy.
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Affiliation(s)
- Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, Norway.
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76
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Tan BK, Zirkle W, Chandra RK, Lin D, Conley DB, Peters AT, Grammer LC, Schleimer RP, Kern RC. Atopic profile of patients failing medical therapy for chronic rhinosinusitis. Int Forum Allergy Rhinol 2012; 1:88-94. [PMID: 21731824 DOI: 10.1002/alr.20025] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an inflammatory condition of the nasal airway and paranasal sinuses that can broadly be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The relationship between CRS and atopy to inhalant allergens remains unclear. We sought to examine the presence of atopy in patients failing medical therapy for both types of CRS. The objective of this research was to analyze the frequency and distribution of allergen sensitivity in patients failing medical therapy for CRSwNP and CRSsNP in comparison to rhinitis patients without CRS and the general population. METHODS A prospectively collected database of 334 consecutive CRS patients who had surgery after failing maximal medical therapy was queried to identify those who met inclusion criteria: a sinus computed tomography (CT), an endoscopy consistent with CRS, and skin-prick testing with 24 common inhalant allergens in 8 classes at our institution (n = 125). Additionally, data from these CRS patients were compared to a group of 50 patients diagnosed with rhinitis who had similar symptoms but radiologically normal CT scans, as well as published normative population skin-prick testing data obtained from the National Health and Nutrition Examination Study III (NHANES III). The relationship between atopy, as assessed by the frequency of skin test positivity, and radiological disease severity, was assessed for several allergen classes in CRSwNP, CRSsNP and rhinitis patients. RESULTS One or more positive skin results were observed in 103 of 125 (82.4%) CRS patients who underwent surgery--a prevalence significantly higher than that found in the NHANES III study (p < 0.05) but not different from the rhinitis control group (36/50, 72.0%). The most prevalent positive skin test results were to dust mites and ragweed in CRSwNP, CRSsNP, and rhinitis patients. Comparing these 3 patient groups, there were no significant differences in the rates of positive skin-test results to any single allergen. However, the median number of skin test–positive results was higher in CRSwNP patients compared to CRSsNP and rhinitis patients. Consistent with other studies, we found that CRSwNP patients were more likely to be male and have concurrent asthma. CONCLUSION In our series of patients failing medical therapy for CRS, we found higher rates of atopy compared with the general population but not compared with rhinitis patients. CRSwNP patients with medically refractory sinusitis were more likely to have multiple positive skin tests and asthma as compared to the general population or patients with either CRSsNP or rhinitis. Host barrier dysfunction may play a role in enabling multisensitization.
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Affiliation(s)
- Bruce K Tan
- Department of Otolaryngology, Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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77
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Konno S, Hizawa N, Fukutomi Y, Taniguchi M, Kawagishi Y, Okada C, Tanimoto Y, Takahashi K, Akasawa A, Akiyama K, Nishimura M. The prevalence of rhinitis and its association with smoking and obesity in a nationwide survey of Japanese adults. Allergy 2012; 67:653-60. [PMID: 22335609 DOI: 10.1111/j.1398-9995.2012.02793.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rhinitis is a common disease, and its prevalence is increasing worldwide. Several studies have provided evidence of a strong association between asthma and rhinitis. Although smoking and obesity have been extensively analyzed as risk factors of asthma, associations with rhinitis are less clear. OBJECTIVE The aims of our study were (i) to evaluate the prevalence of rhinitis using the European Community Respiratory Health Survey (ECRHS) questionnaire in Japanese adults and (ii) to evaluate the associations of smoking and body mass index (BMI) with rhinitis. METHODS Following our study conducted in 2006-2007 to determine the prevalence of asthma using the ECRHS questionnaire, our present analysis evaluates the prevalence of rhinitis and its association with smoking and BMI in Japanese adults 20-79 years of age (N = 22819). We classified the subjects (20-44 or 45-79 years) into four groups as having (i) neither rhinitis nor asthma; (ii) rhinitis without asthma; (iii) asthma without rhinitis; or (iv) rhinitis with asthma. We then evaluated associations with smoking and BMI in each group. RESULTS The overall age-adjusted prevalence of rhinitis was 35.1% in men and 39.3% in women. A higher prevalence was observed in the younger population than in the older population. Active smoking and obesity were positively associated with asthma without rhinitis. In contrast, particularly in the 20- to 44-year age-group, active smoking and obesity were negatively associated with rhinitis without asthma. CONCLUSION The results of the present study suggest that smoking and obesity may have different effects on the development of rhinitis and asthma.
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Affiliation(s)
- S. Konno
- First Department of Medicine; School of Medicine; Hokkaido University; Hokkaido; Japan
| | - N. Hizawa
- Department of Pulmonary Medicine; Institute of Clinical Medicine; University of Tsukuba; Tsukuba; Japan
| | | | - M. Taniguchi
- Clinical Research Center for Allergy and Rheumatology; Sagamihara National Hospital; Kanagawa; Japan
| | - Y. Kawagishi
- Department of Internal Medicine; Kurobe City Hospital; Toyama; Japan
| | | | - Y. Tanimoto
- Department of Hematology, Oncology, Allergy and Respiratory Medicine; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama; Japan
| | - K. Takahashi
- National Hospital Organization; Minami-Okayama Medical Center; Okayama; Japan
| | - A. Akasawa
- Department of Allergy; Tokyo Metropolitan Children's Medical Center; Tokyo; Japan
| | - K. Akiyama
- Clinical Research Center for Allergy and Rheumatology; Sagamihara National Hospital; Kanagawa; Japan
| | - M. Nishimura
- First Department of Medicine; School of Medicine; Hokkaido University; Hokkaido; Japan
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78
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Galli J, Montuschi P, Passàli GC, Laruffa M, Parrilla C, Paludetti G. Exhaled nitric oxide measurement in patients affected by nasal polyposis. Otolaryngol Head Neck Surg 2012; 147:351-6. [PMID: 22470156 DOI: 10.1177/0194599812442322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Nitric oxide (NO) is produced in the respiratory tract with a major contribution coming from paranasal sinuses and the nose. The pathophysiological role of NO in the airways has been debated. The aims of this study were to measure fraction of exhaled NO (FENO), a validated marker of airway inflammation, in patients affected by nasal polyposis with and without asthma; to assess the importance of FENO measurement in detecting subclinical involvement of lower airways in patients with clinical rhinosinusal symptoms; and to clarify the impact of endoscopic surgical removal of polyps on airway inflammation. SETTING The study was conducted at the O.R.L. Clinic and Clinical Pharmacology Unit, University Hospital Agostino Gemelli, Rome, Italy. STUDY DESIGN Prospective study. SUBJECTS AND METHODS Concentrations of FENO were measured with the NIOX system (Aerocrine, Stockholm, Sweden) by using a single-breath online method, according to the American Thoracic Society guidelines. RESULTS Compared with those in healthy subjects (15 [11-19] ppb, n = 15; P < .0001), FENO values were elevated in patients with nasal polyposis (41 [21-77] ppb, n = 43). There was no significant difference in FENO concentrations between asthmatic and nonasthmatic patients with nasal polyposis (P = .73). Concentrations of FENO in patients with nasal polyposis were decreased after surgery (64.2 [30.0-132.7] ppb vs 56.0 [26.4-73.8] ppb, respectively; P = .03). CONCLUSION The fraction of exhaled NO is elevated in the inflammatory process involving both the rhinosinusal district and lower airways, supporting the one-airway disease hypothesis.
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Affiliation(s)
- Jacopo Galli
- ENT Institute, Catholic University of Sacred Heart Rome, Rome, Italy
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79
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Kaur M, Smyth LJC, Cadden P, Grundy S, Ray D, Plumb J, Singh D. T lymphocyte insensitivity to corticosteroids in chronic obstructive pulmonary disease. Respir Res 2012; 13:20. [PMID: 22417244 PMCID: PMC3320534 DOI: 10.1186/1465-9921-13-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 03/14/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There are increased numbers of activated lymphocytes in the lungs of chronic obstructive pulmonary disease (COPD) patients. The clinical benefits of corticosteroids in COPD patients are limited. Our hypothesis is that lymphocytes play a role in this corticosteroid insensitivity. OBJECTIVES To investigate the effects of the corticosteroid dexamethasone on lung lymphocyte cytokine production from patients with COPD compared to controls. METHODS Cultured airway lymphocytes obtained by bronchoscopy from healthy non-smokers (HNS), smokers (S) and COPD patients were stimulated with phytohaemagglutinin (PHA) & phorbol myristate acetate (PMA), +/- dexamethasone. Supernatants were assayed for interleukin (IL)-2 and interferon (IFN)γ. Immunofluoresence was used to analyse changes in CD8 glucocorticoid receptor (GRα and GRβ) expression. RESULTS The inhibition of PHA/PMA stimulated IFNγ production by dexamethasone was reduced in COPD patients compared to HNS (p < 0.05 at concentrations from 0.1-1 μM). There was also a significant reduction (p < 0.05) in the mean inhibitory effect at 1 μM in COPD patients (54.1%) compared to smokers (72.1%), and in smokers compared to HNS (85.5%). There was a numerically reduced effect of dexamethasone on IL-2 production that did not reach statistical significance. There was no difference in GRα and GRβ expression in follicular CD8 cells between COPD patients (50.9% and 30.4% respectively) and smokers (52.9% and 29.7% respectively). CONCLUSIONS IFNγ production from COPD airway lymphocytes is corticosteroid insensitive. This phenomenon may be important in the poor clinical response often observed with corticosteroids.
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Affiliation(s)
- Manminder Kaur
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
| | - Lucy JC Smyth
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
- Centre for Parasitology and Disease, School of Environment and Life Sciences, University of Salford, Salford, UK M5 4WT
| | - Paul Cadden
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
| | - Seamus Grundy
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
| | - David Ray
- School of Medicine, University of Manchester, Oxford Road, Manchester, UK M13 9PT
| | - Jonathan Plumb
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
| | - Dave Singh
- University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, UK M23 9LT
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Håkansson K, von Buchwald C, Thomsen SF, Thyssen JP, Backer V, Linneberg A. Nonallergic rhinitis and its association with smoking and lower airway disease: A general population study. Am J Rhinol Allergy 2011; 25:25-9. [PMID: 21711969 DOI: 10.2500/ajra.2011.25.3556] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The cause of nonallergic rhinitis (NAR) and its relation to lower airway disease remains unclear. The purpose of this study was to perform a descriptive analysis of the occurrence of rhinitis in a Danish general population with focus on NAR and its association with smoking and lower airway disease. METHODS A population-based, cross-sectional study conducted in Copenhagen, Denmark was performed. A random sample from the general population (n = 7931; age, 18-69 years) was invited to a general health examination including measurements of serum-specific immunoglobulin E (IgE) to common aeroallergens; 3471 (44%) persons were accepted. For further analysis, we divided the population into the following groups: (I) negative specific IgE and no rhinitis (controls); (II) negative specific IgE and rhinitis (NAR); (III) positive specific IgE and rhinitis (allergic rhinitis [AR]); and (IV) positive specific IgE but no rhinitis (sensitized). RESULTS We found that NAR was associated with asthma (odds ratio [OR] = 2.51 [1.87-3.37]); chronic bronchitis (OR = 2.27 [1.85-2.79]); current smoking (>15 g/day; OR = 1.57 [1.18-2.08]); lower forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) ratios and reduced FEV(1) values. The association with chronic bronchitis was stronger in NAR than in AR, whereas the opposite was true for asthma. FEV(1)/FVC of <70% was not significantly associated to any group. CONCLUSION This epidemiological study indicates that both asthma and chronic bronchitis are important comorbidities in NAR confirming the "united airway" hypothesis, and that smoking might be a significant modulator of disease. Although NAR was significantly associated with poor lung function, no significant association with chronic obstructive pulmonary disease was shown.
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Affiliation(s)
- Kåre Håkansson
- Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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81
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Kelemence A, Abadoglu O, Gumus C, Berk S, Epozturk K, Akkurt I. The frequency of chronic rhinosinusitis/nasal polyp in COPD and its effect on the severity of COPD. COPD 2011; 8:8-12. [PMID: 21299473 DOI: 10.3109/15412555.2010.540272] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the effect of chronic rhinosinusitis/nasal polyposis on the severity of COPD and to find out whether the 'united airway disease' hypothesis is valid for COPD. The study enrolled 90 patients diagnosed and staged according to criteria of an international guideline for diagnosis and management of COPD. The patients in stages I and II were classified as Group 1 and the patients in stages III and IV as Group 2. All the patients were questioned about the presence of major and minor criteria of sinusitis, underwent paranasal sinus computed tomography (PNS-CT) scans, and answered a questionnaire based on a quality of life test for sinusitis (SNOT-20). Sinusitis was present in 48 (53%) patients according to criteria of major and minor symptoms, and in 58 (64%) patients according to Lund-Mackay scoring system of PNS-CT. There was no significant difference in CT score between Group 1 and Group 2 (2.3 +/- 0.5 vs. 2.1 +/- 0.4, p > 0.05). However, the frequency of minor symptoms was greater in Group 2. SNOT-20 score was significantly higher in Group 2 than in Group 1 (28.7 +/- 1.7 and 22.2 +/- 1.9, respectively, p = 0.014). A significant correlation was determined between Lund-Mackay and SNOT-20 scores. The presence of CRS should be assessed in COPD patients, especially in those with severe disease. Further research is needed to disclose possible common immunopathological mechanisms in the pathogeneses of COPD and CRS.
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Affiliation(s)
- Alper Kelemence
- Cumhuriyet University, Faculty of Medicine, Department of Chest Diseases, Sivas, Turkey
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82
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Guilemany JM, Alobid I, Mullol J. Controversies in the treatment of chronic rhinosinusitis. Expert Rev Respir Med 2010; 4:463-77. [PMID: 20658908 DOI: 10.1586/ers.10.49] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease involving the mucosa of the nose and one or more paranasal sinuses. Despite differing hypotheses, the cause remains poorly understood. The key issue is the maintaining of ostial patency. CRS with nasal polyps is considered to be a subgroup of CRS. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, post-nasal drip, and facial pain or pressure. CRS is associated with lower airway disease such asthma, chronic obstructive pulmonary disease and bronchiectasis. In CRS with and without nasal polyps, medical treatment, including nasal and oral corticosteroids, is the first therapeutic option. The treatment of CRS still remains an unmet need. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating airway inflammatory diseases such as asthma, allergic rhinitis and CRS. Endoscopic sinus surgery is only recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.
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Affiliation(s)
- José Maria Guilemany
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Clínic i Universitari de Barcelona, c/ Villarroel, 170, Barcelona 08036, Catalonia, Spain.
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83
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Chawes BLK, Bønnelykke K, Kreiner-Møller E, Bisgaard H. Children with allergic and nonallergic rhinitis have a similar risk of asthma. J Allergy Clin Immunol 2010; 126:567-73.e1-8. [PMID: 20816191 DOI: 10.1016/j.jaci.2010.06.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both allergic and nonallergic rhinitis have been associated with increased prevalence of asthma. OBJECTIVE To characterize asthma and intermediary asthma endpoints in young children with allergic and nonallergic rhinitis. METHODS Thirty-eight 7-year-old children with allergic rhinitis, 67 with nonallergic rhinitis, and 185 without rhinitis from the Copenhagen Prospective Study on Asthma in Childhood birth cohort were compared for prevalence of asthma, eczema, food sensitization, filaggrin null-mutations, total IgE, blood eosinophil count, fractional exhaled nitric oxide (FeNO), lung function, and bronchial responsiveness. RESULTS Children with allergic rhinitis compared with asymptomatic controls had increased prevalence of asthma (21% vs 5%; P = .002), food sensitization (47% vs 13%; P < .001), and eczema (66% vs 43%; P = .01) and increased total IgE (155 kU/L vs 41 kU/L; P < .001), blood eosinophil count (0.46 x 10(9)/L vs 0.30 x 10(9)/L; P = .01), FeNO (15.9 ppb vs 6.6 ppb; P < .001), and bronchial hyperresponsiveness (23% vs 9%; P = .008). Filaggrin null-mutations were associated with allergic rhinitis (odds ratio, 3.3; 95% CI, 1.3-8.3) but did not modify these associations. Children with nonallergic rhinitis also had increased asthma prevalence (20% vs 5%; P = .001) but showed no association with filaggrin null-mutations, eczema, food sensitization, total IgE, blood eosinophil count, FeNO, or bronchial responsiveness. CONCLUSION Asthma is similarly associated with allergic and nonallergic rhinitis, suggesting a link between upper and lower airways beyond allergy associated inflammation. Only children with allergic rhinitis had increased bronchial responsiveness and elevated FeNO, suggesting different endotypes of asthma symptoms in young children with allergic and nonallergic rhinitis.
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Affiliation(s)
- Bo Lund Krogsgaard Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, and the Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
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84
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Möller W, Münzing W, Canis M. Clinical potential of pulsating aerosol for sinus drug delivery. Expert Opin Drug Deliv 2010; 7:1239-45. [PMID: 20874262 DOI: 10.1517/17425247.2010.523078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a high incidence of nasal disorders including chronic rhinosinusitis (CRS), affecting ∼ 14% of the total population. However, a topical treatment regimen shows only modest efficacy, and drug delivery to the posterior nose, osteomeatal area, and paranasal sinuses is still a challenge. Therefore, the primary treatment option of CRS is functional endonasal sinus surgery (FESS). Most nasally administered aerosolized drugs are efficiently filtered by the nasal valve and do not reach the sinuses, the site of chronic inflammation. Sinus ventilation, nasal and paranasal aerosol deposition can be achieved by using a pulsating airflow, offering new topical treatment options for nasal disorders. Inhalation studies in nasal casts and in healthy volunteers have shown up to 8% of the nasally deposited drug within the sinuses, which could not be achieved using nasal pump sprays. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposit in the nose was prolonged by about a factor of five. With this efficiency, topical aerosol therapies of sinus disorders can be achieved and, owing to the prolonged retention, reduced application modes are possible. This offers new treatment options of sinus-nasal disorders in comparison with or after FESS.
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Affiliation(s)
- Winfried Möller
- Institute for Lung Biology and Disease, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstrasse 1, Neuherberg, Germany.
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Abstract
Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.
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Affiliation(s)
- Peter W Hellings
- Department of Otorhinolaryngology, Head, and Neck Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000, Belgium.
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Bachert C, Claeys SEM, Tomassen P, van Zele T, Zhang N. Rhinosinusitis and asthma: a link for asthma severity. Curr Allergy Asthma Rep 2010; 10:194-201. [PMID: 20424997 DOI: 10.1007/s11882-010-0096-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The term rhinosinusitis describes an inflammation of the mucosal lining of the nose and sinuses; however, recent evidence points to the need to differentiate patients with chronic rhinosinusitis without nasal polyps from those with nasal polyps. Asthma comorbidity is especially common in nasal polyp disease and may be associated with aspirin-exacerbated respiratory disease. Of interest, asthma comorbidity is uncommon in some parts of the world but common in others. A further analysis of the inflammatory patterns also revealed that nasal polyps do not represent one single entity; interleukin (IL)-5-positive nasal polyps can be differentiated from IL-5-negative forms by different inflammatory patterns (predominance of eosinophils vs neutrophils). Staphylococcus aureus superantigens frequently colonize IL-5-positive nasal polyps and may amplify the eosinophilic inflammation, induce a polyclonal local IgE formation, and increase the risk of asthma comorbidity. Recent findings in severe asthma patients confirm the role of superantigens in lower airway disease.
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Affiliation(s)
- C Bachert
- Upper Airway Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
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Kjærgaard T, Cvancarova M, Steinsvåg SK. Cigarette smoking and self-assessed upper airway health. Eur Arch Otorhinolaryngol 2010; 268:219-26. [PMID: 20512499 DOI: 10.1007/s00405-010-1287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
Habitual smoking represents a chronic insult to the airway. However, the effects of smoking on upper airway health remains poorly described. Our objective was to examine the relationship between cigarette smoking and self-assessed upper airway health and evaluate dose-response relationships between exposure and complaints in a sample of 2,523 patients. Eligible subjects were adults referred to ENT specialist for evaluation of chronic nasal or sleep-related complaints. Thirteen specific symptoms and conditions, mainly related to the upper airway, were graded based on visual analog scales (VAS). Smokers, representing 33% of the sample, were more likely to report severe upper airway complaints compared to non-smokers (odds ratio 1.31-2.08) and exhibited significantly higher visual analog scale scores than non-smokers for 9 out of 13 outcome variables (p < 0.001-0.007). Further, significant associations were found between cigarette consumption and severity of complaints (p < 0.001-0.01), heavy smokers generally being more likely to exhibit high VAS scores than light smokers. In several cases smoking status and self-reported asthma/allergy had similar impact on subjective outcomes. Cigarette smoking was clearly associated with impaired upper airway health and seemed to be an important determinant in subjects seeking medical attention due to chronic nasal or sleep-related complaints. Both threshold and dose-response like relationships were evident between cigarette consumption and the outcome measures.
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Affiliation(s)
- Thomas Kjærgaard
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
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Abstract
The interaction between upper and lower airway disease has been recognized for centuries, with recent studies showing a direct link between upper and airway inflammation in allergic patients. The mechanisms underlying the interaction between nasal and bronchial inflammation have primarily been studied in allergic disease, showing systemic immune activation after allergen inhalation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. Therefore, allergic rhinitis and asthma are considered part of the global airway allergy syndrome. Besides allergy, other inflammatory conditions such as the common cold, acute rhinosinusitis, and chronic rhinosinusitis are associated with lower airway disease. Chronic sinus disease with or without nasal polyps are frequently found in patients with asthma and chronic obstructive pulmonary disease with improvement of bronchial symptoms and respiratory function by adequate medical and surgical therapy for rhinosinusitis. The resolution of sinonasal inflammation and hence sinonasal functions by medical or surgical treatment is considered responsible for the beneficial effect of treatment on bronchial disease. This article aims at providing a comprehensive overview of the current knowledge on the interaction between common cold, acute and chronic rhinosinusitis, and lower airway biology.
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Affiliation(s)
- Peter W Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Catholic University of Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
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89
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Janssens W, Nuytten H, Dupont LJ, Van Eldere J, Vermeire S, Lambrechts D, Nackaerts K, Decramer M, Cassiman JJ, Cuppens H. Genomic copy number determines functional expression of {beta}-defensin 2 in airway epithelial cells and associates with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 182:163-9. [PMID: 20378733 DOI: 10.1164/rccm.200905-0767oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Copy number variations of the cluster of beta-defensin genes have been associated with psoriasis and inflammatory bowel disease. Controversy still exists on whether the beta-defensins genes determine susceptibility for chronic obstructive pulmonary disease (COPD). OBJECTIVES We investigated whether genomic copy number variations of the beta-defensin gene cluster have a functional role in airway epithelial cells and associate with the presence of COPD. METHODS Baseline and inflammatory induced transcript expression of DEFB4 was studied in nasal epithelial cell cultures and its effect on Pseudomonas aeruginosa inhibition was assessed. Subsequently, relevant functional cut-offs for copy numbers were used to explore associations with COPD in two independent case-control studies. MEASUREMENTS AND MAIN RESULTS Copy number variation in the beta-defensin encoding genes correlated with baseline mRNA DEFB4 expression levels (R(2) = 0.96; P = 0.02), with a plateau effect from five copies or more. Only when higher copy numbers of beta-defensin genes were present, transcription was significantly up-regulated by tumor necrosis factor-alpha (P < 0.0001), which resulted in better antimicrobial activity in vitro. When comparing healthy smokers with COPD patients, a copy number greater than or equal to 5 was associated with increased risk for COPD with an adjusted odds ratio of 1.8 (confidence interval, 1.1-2.8; P = 0.02), which was confirmed by a second independent case-control study. CONCLUSIONS Genomic copy number variation of beta-defensin encoding genes has a functional role in airway epithelial cells, which may contribute to the pathogenesis of COPD.
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Affiliation(s)
- Wim Janssens
- Department of Human Genetics, Katholieke Universiteit Leuven, Gasthuisberg O&N1 (602), Herestraat 49, B-3000, Leuven, Belgium
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90
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Combined airways: impact of upper airway on lower airway. Curr Opin Otolaryngol Head Neck Surg 2010; 18:15-20. [PMID: 19915468 DOI: 10.1097/moo.0b013e328334aa0e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent literature on the important relationship between the nose, paranasal sinuses and lungs. Recent advances in the understanding of the pathophysiological mechanisms underlying the association between upper and lower airways are discussed. RECENT FINDINGS Epidemiological, clinical, and immunopathological data demonstrate an important link between upper and lower airways beyond the well recognized association of allergic rhinitis and asthma. Other upper airway diseases including occupational rhinitis, chronic rhinosinusitis, nasal polyposis with or without aspirin sensitivity, and obstructive sleep apnea have all been linked to asthma and/or asthma severity, as well as other lower airway diseases. Although the underlying mechanisms to explain these associations are unclear, recent work suggests the presence of systemic inflammation triggered by both the adaptive and innate immune system as a major driving force in combined airway diseases. SUMMARY Epidemiological data, clinical observations, and immunopathological studies demonstrate an important link between upper and lower airways. An understanding of how the upper airway impacts on lower airway disease has important diagnostic, therapeutic and prognostic implications.
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91
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Górska K, Maskey-Warzęchowska M, Krenke R. Airway inflammation in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2010; 16:89-96. [DOI: 10.1097/mcp.0b013e3283341ba0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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92
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Current World Literature. Curr Opin Pulm Med 2010; 16:162-7. [DOI: 10.1097/mcp.0b013e32833723f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Chawes BLK, Kreiner-Møller E, Bisgaard H. Upper and lower airway patency are associated in young children. Chest 2010; 137:1332-7. [PMID: 20118204 DOI: 10.1378/chest.09-2601] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although allergic rhinitis and asthma frequently coexist, the nature of this association is poorly understood. Therefore, we examined whether upper and lower airway patency are associated. METHODS We investigated 221 6-year-old children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort, assessing upper airway patency by acoustic rhinometry before and after alpha-agonist, and lower airway patency by spirometry before and after beta2-agonist. Furthermore, we measured blood eosinophil count, nasal eosinophilia, total IgE, and fraction of exhaled nitric oxide. Associations were investigated by generalized linear models. RESULTS Decongested nasal airway patency and post-beta2 FEV(1) were significantly associated (P = .007). The association remained significant after adjustments for sex, body size, FVC, and atopic diseases (beta-coefficient 2.85 cm(3); 95% CI, 0.42 to 5.29; P = .02). Baseline values of upper and lower airway patency were also significantly associated (beta-coefficient 0.89 cm(3); 95% CI, 0.26-1.51; P = .01). In addition, blood eosinophil count and nasal eosinophilia were inversely associated with decongested nasal airway patency, beta-coefficient -0.42 cm(3) (95% CI, -0.77 to -0.07; P = .02) and beta-coefficient -0.47 cm(3) (95% CI, -0.89 to -0.05; P = .03), respectively. CONCLUSIONS We found a strong and consistent association between upper and lower airway patency. This may be due to a common pathology, as suggested by the inverse association between decongested nasal airway patency, blood eosinophil count, and nasal eosinophilia. Alternatively, the association between upper and lower airway patency might reflect a physiologic background for the common comorbidity.
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94
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Steinsvåg SK. [Nose and lungs--two of a kind]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1982-4. [PMID: 19823201 DOI: 10.4045/tidsskr.08.0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Diseases in the upper and lower airways often occur concomitantly, and evidence indicates a close relationship between them. Optimal treatment of airway disease requires knowledge about this relationship; the article presents an updated overview of the field. MATERIAL AND METHODS This paper is based on extensive clinical experience with airway disease, own research and literature studies. RESULTS It is well documented that patients suffering from asthma have rhinitis more often than those without. Likewise, those suffering from nose and sinus disease, e.g. allergic rhinitis, sinusitis and nasal polyposis, have an increased incidence of asthma. Treatment of disorders in one airway compartment often has a positive impact on the airways in general. INTERPRETATION Disorders in the upper and lower airways should be considered as the same disease to a larger extent than they are today. Patients with disease in one airway compartment should be considered for pathology elsewhere in the airways. Therapeutically, the airways should be regarded as one entity.
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Affiliation(s)
- Sverre K Steinsvåg
- Øre-nese-hals-avdelingen, Sørlandet sykehus, 4604 Kristiansand og Øre-nese-hals-avdelingen, Haukeland universitetssykehus, Norway.
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95
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Toste JMG, Vallés CP, Mullol i Miret J. A United Airway: Bronchiectasis Is Also Associated With Chronic Rhinosinusitis and Nasal Polyps. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1579-2129(09)73408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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96
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Taegtmeyer AB, Steurer-Stey C, Price DB, Wildhaber JH, Spertini F, Leuppi JD. Predictors of asthma control in everyday clinical practice in Switzerland. Curr Med Res Opin 2009; 25:2549-55. [PMID: 19735165 DOI: 10.1185/03007990903224125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify predictors of improved asthma control under conditions of everyday practice in Switzerland. RESEARCH DESIGN AND METHODS A subgroup of 1380 patients with initially inadequately controlled asthma was defined from a cohort of 1893 asthmatic patients (mean age 45.3 + or - 19.2 years) recruited by 281 office-based physicians who participated in a previously-conducted asthma control survey in Switzerland. Multiple regression techniques were used to identify predictors of improved asthma control, defined as an absolute decrease of 0.5 points or more in the Asthma Control Questionnaire between the baseline (V1) and follow-up visit (V2). RESULTS Asthma control between V1 and V2 improved in 85.7%. Add-on treatment with montelukast was reported in 82.9% of the patients. Patients with worse asthma control at V1 and patients with good self-reported adherence to therapy had significantly higher chances of improved asthma control (OR = 1.24 and 1.73, 95% CI 1.18-1.29 and 1.20-2.50, respectively). Compared to adding montelukast and continuing the same inhaled corticosteroid/fixed combination (ICS/FC) dose, the addition of montelukast to an increased ICS/FC dose yielded a 4 times higher chance of improved asthma control (OR = 3.84, 95% CI 1.58-9.29). Significantly, withholding montelukast halved the probability of achieving improved asthma control (OR = 0.51, 95% CI = 0.33-078). The probability of improved asthma control was almost 5 times lower among patients in whom FEV(1) was measured compared to those in whom it was not (OR = 0.23, 95% CI = 0.09-0.55). Patients with severe persistent asthma also had a significantly lower probability of improved control (OR = 0.15, 95% CI = 0.07-0.32), as did older patients (OR = 0.98, 95% CI = 0.97-0.99). Subgroup analyses which excluded patients whose asthma may have been misdiagnosed and might in reality have been chronic obstructive pulmonary disease (COPD) showed comparable results. CONCLUSIONS Under conditions of everyday clinical practice, the addition of montelukast to ICS/FC and good adherence to therapy increased the likelihood of achieving better asthma control at the follow-up visit, while older age and more severe asthma significantly decreased it.
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Affiliation(s)
- Anne B Taegtmeyer
- Medical Outpatient Clinic and Department of Internal Medicine, University Hospital Basel, Switzerland
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97
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Guilemany JM, Angrill J, Alobid I, Centellas S, Prades E, Roca J, Pujols L, Bernal‐Sprekelsen M, Picado C, Mullol J. United airways: the impact of chronic rhinosinusitis and nasal polyps in bronchiectasic patient's quality of life. Allergy 2009; 64:1524-1529. [PMID: 19772517 DOI: 10.1111/j.1398-9995.2009.02011.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The nose and the bronchi belong, in anatomical and physiopathological terms, to the concept of united airways. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis (NP) and asthma, chronic rhinosinusitis (CRS) and chronic obstructive pulmonary disease, and more recently CRS/NP and bronchiectasis (BQ). OBJECTIVE To evaluate the impact of CRS on quality of life (QoL) of patients with BQ, and to correlate these findings with the pulmonary status, nasal symptoms, and general health status. METHODS In a prospective study, patients with BQ (n = 80) were evaluated for CRS and NP using EP(3)OS criteria, and severity of BQ using chest high resolution computed tomography (HRCT)-scan. Quality of life was assessed in all patients by using specific [Sinonasal Outcome Test-20 (SNOT-20), St George Respiratory Questionnaire (SGRQ)], and generic (Short Form-36; SF-36) questionnaires. RESULTS Using SNOT-20, patients with CRS had worse QoL (2.1 +/- 0.1; P < 0.001) than patients without CRS (0.4 +/- 0.06). Using SGRQ total score, patients with CRS had worse QoL (43.7 +/- 2.2; P < 0.001) than patients without CRS (24.7 +/- 2.5). Using SF-36, patients with CRS had worse QoL, both in the physical summary (64 +/- 3.4; P < 0.05) and the mental summary (65.5 +/- 4.7; P < 0.05), than patients without CRS (physical summary [PS]: 76.2 +/- 3.3; mental summary [MS]: 78.3 +/- 5.3, respectively). Sinonasal Outcome Test-20 was correlated with SGRQ total score (r = 0.72; P < 0.01), and SF-36 physical summary (r = -0.63; P < 0.01). St George Respiratory Questionnaire was correlated with SF-36 on physical summary (r = -0.58; P < 0.05) and with forced expiratory volume in 1 s (r = -0.41; P < 0.05). CONCLUSION These results suggested that CRS, measured by both specific and generic questionnaires, has a considerable impact on the QoL of patients with BQ.
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Affiliation(s)
- J. M. Guilemany
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - J. Angrill
- Pneumology and Respiratory Allergy, Hospital Clínic, Barcelona
| | - I. Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - S. Centellas
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - E. Prades
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
| | - J. Roca
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - L. Pujols
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - M. Bernal‐Sprekelsen
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - C. Picado
- Pneumology and Respiratory Allergy, Hospital Clínic, Barcelona
- Department of Medicine, University of Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
| | - J. Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona
- Department of Medicine, University of Barcelona, Barcelona
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Barcelona, Spain
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98
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Guilemany Toste JM, Picado Vallés C, Mullol i Miret J. Una vía respiratoria unificada: las bronquiectasias también se asocian a rinosinusitis crónica y pólipos nasales. Arch Bronconeumol 2009; 45:525-6; author reply 526. [DOI: 10.1016/j.arbres.2009.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/18/2009] [Indexed: 11/27/2022]
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99
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Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009; 34:447-54. [PMID: 19793277 DOI: 10.1111/j.1749-4486.2009.01995.x] [Citation(s) in RCA: 1008] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Hopkins
- Guy' and St Thomas' NHS Foundation Trust, London, UK.
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100
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Current world literature. Curr Opin Allergy Clin Immunol 2009; 9:79-85. [PMID: 19106700 DOI: 10.1097/aci.0b013e328323adb4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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