Extrathoracic and intrathoracic airway responsiveness in sinusitis.
BACKGROUND
Asthma associated with sinusitis is supposed to be sustained by bronchoconstrictive reflexes originating in extrathoracic airway (EA) receptors.


OBJECTIVE
The study was designed to evaluate the relationship between EA responsiveness and bronchial responsiveness in sinusitis.


METHODS
We performed histamine inhalation challenge in 106 patients with chronic sinusitis, during disease exacerbation and after treatment with antimicrobials and nasal flunisolide (100 micrograms daily) for 2 weeks. Forced expiratory volume in 1 second (FEV1) and maximal mid-inspiratory flow (MIF50) were the respective indexes of bronchial and EA narrowing; the histamine concentrations causing a 20% fall in FEV1 (PC20) and 25% drop in MIF50 (PC25MIF50) were used as thresholds of bronchial and EA responsiveness. Thresholds of 8 mg/ml or less were assumed to indicate bronchial hyperresponsiveness (B-HR) or EA hyperresponsiveness (EA-HR).


RESULTS
During sinusitis exacerbation 76 patients had EA-HR, which in 46 was associated with B-HR. The values of PC20 were closely related with those of PC25MIF50 (p < 0.001). EA-HR and B-HR were strongly associated with pharyngitis. After treatment, mean PC25MIF50 and PC20 were significantly increased (p < 0.001). The improvement of PC25MIF50 was closely related to that of PC20 (p < 0.001) and to the decrease in neutrophils in nasal lavage (p < 0.05). EA-HR reversed in 58 patients and improved in 10; B-HR reversed in 29 and improved in 12.


CONCLUSIONS
Our findings suggest that in sinusitis, B-HR may be sustained by constrictive reflexes originating in pharyngeal receptors, made hypersensitive by seeding of the inflammatory process.
Bucca
C
C
Department of Biomedical Sciences and Human Oncology, University of Torino, Italy.
Rolla
G
G
Scappaticci
E
E
Chiampo
F
F
Bugiani
M
M
Magnano
M
M
D'Alberto
M
M
D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D001985:Bronchial Provocation Tests / Q000379:methods / Q000706:statistics & numerical data; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005446:Fluocinolone Acetonide / Q000031:analogs & derivatives / Q000627:therapeutic use; D006632:Histamine / Q000008:administration & dosage; D006801:Humans; D016014:Linear Models; D008297:Male; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005446:Fluocinolone Acetonide; C007734:flunisolide; D006632:Histamine