Sinonasal pathology in nonallergic asthma and COPD: 'united airway disease' beyond the scope of allergy.
BACKGROUND
In contrast to the epidemiological and clinical association between allergic rhinitis and asthma, upper airway inflammation is less characterized in patients with nonatopic asthma and virtually unexplored in chronic obstructive pulmonary disease (COPD). Here, sinonasal pathology is studied in patients with allergic asthma, nonallergic asthma and COPD.


METHODS
Ninety patients with stable bronchial disease were included in the study, of which 35 were diagnosed with allergic asthma, 24 with nonallergic asthma and 31 with COPD. Concurrently, 61 control subjects without pulmonary disease were included and matched for age and smoking habits respectively with the asthma and the COPD group. Sinonasal symptoms were evaluated on a visual analogue scale and rhinosinusitis-related impairment of quality of life was assessed with the sino-nasal outcome test-22 (SNOT-22) questionnaire. Nasal mucosal abnormalities were quantified with nasal endoscopy and nasal secretions collected for measuring inflammatory mediators.


RESULTS
Allergic asthmatics, nonallergic asthmatics and COPD patients reported more nasal symptoms than their respective control subjects, had a higher SNOT-22 score and presented more mucosal abnormalities in the nose. Nasal secretions of both allergic and nonallergic asthmatics contained higher levels of eotaxin, G-CSF, IFN-gamma and MCP-1 than controls. Allergic asthmatics had higher nasal IP-10 levels as well. COPD-patients had higher nasal levels of eotaxin, G-CSF and IFN-gamma than controls.


CONCLUSIONS
Patients with allergic and nonallergic asthma and COPD show increased nasal symptoms and more nasal inflammation. Hence, our data confirm the 'united airways' concept to be beyond the scope of allergic asthma.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
G
G
Hens
B M
BM
Vanaudenaerde
D M A
DM
Bullens
M
M
Piessens
M
M
Decramer
L J
LJ
Dupont
J L
JL
Ceuppens
P W
PW
Hellings
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D018836:Inflammation Mediators / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D010256:Paranasal Sinuses / Q000503:physiopathology*; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011788:Quality of Life; D012129:Respiratory Function Tests; D020545:Respiratory Mucosa / Q000473:pathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012852:Sinusitis / Q000175:diagnosis* / Q000453:epidemiology; D012882:Skin Tests; D018709:Statistics, Nonparametric
D018836:Inflammation Mediators