A prospective study of nasal disease in adult cystic fibrosis

Chronic infection with Pseudomonas aeruginosa in cystic fibrosis: a risk factor for nasal polyposis after lung transplantation

BACKGROUND

Nasal polyposis (NP) is common in cystic fibrosis (CF) patients. The prevalence of the CF phenotype with NP after lung transplantation (LTx) is unknown. Risk factors for the development of NP after LTx are not well described.

METHODS

CF patients with LTx at our center between November 1992 and December 2009 were included. They were regularly investigated with nasal endoscopy and aspiration of sinus secretions with microbiological evaluation. Patients with and without development of NP were compared along the following parameters: gender, age, dF508, diabetes, acute rejection, NP at LTx, and microbiology of the sinuses before and after LTx. A multivariate Cox regression analysis was performed.

RESULTS

The study included 94 patients; 21 were excluded because of incomplete data. Thirty-five (48%) of the remaining 73 patients developed NP. Mean time to diagnosis of NP was 4.2 (2.9-5.6) years after LTx. Prevalence of NP was 11% after the first year and 18%, 33%, and 44% after the first 2, 5, and 10 years, respectively. Patients with posttransplantation NP were younger, had NP before LTx, and were chronically infected with Pseudomonas aeruginosa (PA) in the nose. Multivariate analysis demonstrated that chronic infection with PA was the only significant risk factor for the development of nasal polyps after LTx (hazards ratio, 7.2; 95% confidence interval, 2.1-24.2; P=0.001).

CONCLUSIONS

In contrast to pretransplantation patients, NP is more common after LTx. Development of NP occurs throughout the whole observation time. Chronic sinonasal PA infection seems to be the only significant risk factor for NP after LTx.

Nasal polyposis in lung transplant recipients with cystic fibrosis

BACKGROUND

Chronic rhinosinusitis with nasal polyposis is common in patients with cystic fibrosis (CF). There are still many open questions regarding factors related to this condition. Furthermore, the prevalence of nasal polyposis and its implications for the outcomes in lung transplant recipients with cystic fibrosis are unknown.

METHODS

All CF patients who underwent lung transplantation at our centre between November 1992 and December 2009 were included. Nasal polyp status was determined endoscopically at time sinus surgery and its relationships to gender, age at lung transplantation, Liou raw score, body mass index, FEV1%predicted, diabetes mellitus, pre-transplant pseudomonas colonisation of the sinuses and the lungs, pre-transplant corticosteroid use and type of mutation of the CFTR gene were analysed. The post-transplant survival times and the incidence of bronchiolitis obliterans syndrome in patients with or without nasal polyposis were compared.

RESULTS

Nasal polyps were found in 19% (17 patients) of the 89 lung transplant recipients, whose data was available for statistical analysis. None of the factors analysed was related to the nasal polyp status. The post-transplant survival times and the incidence of bronchiolitis obliterans syndrome did not significantly differ between patients with or without nasal polyposis.

CONCLUSIONS

CF-related nasal polyposis occurs in a relevant fraction of lung transplant recipients. A specific effect of nasal polyposis on post-transplant outcome could not be confirmed. Nevertheless, there was a trend to NP recurrence in patients with post-transplant sinonasal pseudomonas colonisation and is a tendency of less chronic rejection in CF patients with nasal polyps.

Creation of a standardized geometry of the human nasal cavity

A novel, standardized geometry of the human nasal cavity was created by aligning and processing 30 sets of computed tomography (CT) scans of nasal airways of healthy subjects. Digital three-dimensional (3-D) geometries of the 60 single human nasal cavities (30 right and 30 mirrored left cavities) were generated from the CT scans and measurements of physical parameters of each single nasal cavity were performed. A methodology was developed to scale, orient, and align the nasal geometries, after which 2-D digital coronal cross-sectional slices were generated. With the use of an innovative image processing algorithm, median cross-sectional geometries were created to match median physical parameters while retaining the unique geometric features of the human nasal cavity. From these idealized 2-D images, an original 3-D standardized median human nasal cavity was created. This new standardized geometry was compared against the original geometries of all subjects as well as limited existing data from the literature. The new model has potential for use as a geometric standard in future experimental and numerical studies of deposition of inhaled aerosols, as well as for use as a reference during diagnosis of unhealthy patients. The specific procedure developed could also be applied to build standard nasal geometries for different identifiable groups within the larger population.

Immune response to Mycoplasma pulmonis in nasal mucosa is modulated by the normal microbiota

The impact of commensal bacteria on lymphocyte responses in the upper airways was studied in rat nasal mucosa after infection with the pathogen Mycoplasma pulmonis. Phenotyping was performed in situ by paired immunofluorescence staining in germ-free (GF) and conventional (CV) rats before and 3 wk after the monoinfection. Intraepithelial lymphocytes had expanded significantly in GF (P = 0.02) but not in CV rats. Furthermore, a striking proportional increase of T-cell receptor (TCR)alphabeta(+)CD4(+) cells was observed both in the lamina propria and epithelium of GF (P < 0.01) but not of CV rats. Notably, in contrast to the pre-infection state, both mucosal compartments showed a percentage of TCRalphabeta(+)CD4(+) cells that was significantly higher in GF (P = 0.03-P < 0.01) than in CV rats after the monoinfection. In parallel, both compartments displayed a percentage of TCRalphabeta(+) CD8(+) cells that was decreased in GF (P < 0.01) but not in CV rats. The small fraction of TCRgammadelta(+) T cells observed (< 5%) did not change quantitatively or phenotypically after infection. The size of organized nose-associated lymphoid tissue was, on average, increased 5.2-fold in GF rats versus 2.6-fold in CV rats. Collectively, our results demonstrated that the normal microbiota modulated markedly the nasal immune response elicited by monoinfection with M. pulmonis.

Clinical characteristics and genotype analysis of patients with cystic fibrosis and nasal polyposis

The prevalence of nasal polyps in a group of paediatric patients with cystic fibrosis was prospectively studied in comparison with a control group with cystic fibrosis but without polyps. Clinical variables, including pulmonary function tests, skin testing and mucociliary transport, were carried out in both groups, as well as genotype analysis. Endoscopic intranasal evaluation identified polyps in 29 of 89 patients (33%). Statistical analysis revealed that patients with nasal polyposis had better pulmonary function, a higher rate of Pseudomonas aeruginosa colonization, more hospitalizations, and more prevalence of allergy to Aspergillus fumigatus than did the comparison group. We found no statistically different genotype distribution between the polyposis and the control group. However, it can be emphasized that the prevalence of the compound heterozygous genotype is higher in the nasal polyposis group than in controls. Our observations suggest that other genetic and environmental factors could play an important role in the development of nasal polyposis.

Nasal polyps in cystic fibrosis: clinical endoscopic study with nasal lavage fluid analysis

STUDY OBJECTIVES

Nasal polyps frequently appear in patients with cystic fibrosis (CF). The aims of this study were to focus on what problems (symptoms, endoscopic findings, and laboratory correlates) nasal polyps cause the CF patient, and how these correlate to the total health situation of this patient group.

PATIENTS AND STUDY DESIGN

The clinical histories, endoscopic investigations of the nasal cavity, and analyses of nasal lavage fluid of 44 patients with CF complicated with nasal polyposis have been compared with those of 67 CF control subjects. The patients were examined at annual control examinations (with pulmonary tests, working capacity, liver tests, and bacterial and blood tests) from 1995 to 1996 at Stockholm Cystic Fibrosis Center, Huddinge University Hospital. All patients were > 2 years of age. The endoscopic findings were related to the actual pulmonary function, inflammatory blood parameters, colonizing pathogens, antibodies (Staphylococcus aureus and Pseudomonas aeruginosa), and genotype.

RESULTS

The patients with nasal polyps differed with respect to chronic colonization of P aeruginosa in sputum samples and had a higher occurrence of serum antibodies against the same species. The two groups did not differ in pulmonary functions, inflammatory parameters, or genotype. The polyps found were mainly small (within the meatus media) and gave no significant increase in ongoing clinical symptoms such as rhinorrhea, nasal obstruction, or hyposmia. Neither was any significantly marked finding concerning the nose (mucosal swellings, secretion, etc.) made in the polyp patients. The patients with CF scored slightly lower in a smell identification test in comparison with the healthy control group. The nasal lavage fluid was analyzed (in 93 of the 111 patients) for the occurrence of P aeruginosa (by polymerase-chain reaction [PCR]), interleukin [IL]-5, IL-8, and lysozyme. The lysozyme and IL-8 content was equal in the two CF groups but increased in comparison with the healthy control group. P aeruginosa was not detected with PCR in any nasal lavage fluid. No measurable levels of IL-5 in the nasal lavage were found.

CONCLUSIONS

There was a higher frequency of chronic colonization of P aeruginosa in the lower respiratory tract in patients with nasal polyps. Otherwise, nonsevere nasal polyposis was not an indicator of lower respiratory tract morbidity in CF patients.