Nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis.
BACKGROUND
A decrease in nasal nitric oxide (NO) and an increase in exhaled NO have been demonstrated in patients with nasal polyposis (NP).


OBJECTIVE
The aims were to evaluate the flux of NO from the three compartments of the respiratory tract, namely, upper nasal, lower conducting and distal airways, and to search for relationships between NO parameters and indexes of upper and lower disease activity (bronchial reactivity and obstruction). The effect of medical treatment of polyposis was also evaluated.


METHODS
Seventy patients with polyposis were recruited. At baseline, pulmonary function tests (spirometry, plethysmography, bronchomotor response to deep inspiration using forced oscillation measurement of resistance of respiratory system, methacholine challenge, multiple flow rates of exhaled NO and nasal NO measurements) were performed together with an assessment of polyposis [clinical, endoscopic and computed tomography (CT) scores].


RESULTS
Statistical relationships were demonstrated between nasal NO flux and severity scores (clinical: rho=-0.31, P=0.015; endoscopic: rho=-0.57, P<0.0001; CT: rho=-0.46, P=0.0005), and between alveolar NO concentration and distal airflow limitation (FEF(25-75), rho=-0.32, P=0.011). Thirty-six patients were assessed after 11 [7-13] (median [interquartile]) months of medical treatment, demonstrating an improvement in clinical and endoscopic scores, an increase in nasal NO flux, a decrease in NO flux from conducting airways, an improvement in the mild airflow limitation (forced expiratory volume in 1 s, FEF(25-75), even in non-asthmatic patients) and a decrease in the bronchoconstrictor effect of deep inspiration.


CONCLUSIONS
The medical treatment of NP improves both airway reactivity and obstruction, whatever the presence of asthma, suggesting a functional link between upper and lower airway functions.
Delclaux
C
C
Faculté de Médecine Paris Descartes, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie, Clinique de la dyspnée, Paris, Cedex, France. christophe.delclaux@egp.aphp.fr
Malinvaud
D
D
Chevalier-Bidaud
B
B
Callens
E
E
Mahut
B
B
Bonfils
P
P
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology*; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology*; D001944:Breath Tests; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068656:Mometasone Furoate; D009298:Nasal Polyps / Q000188:drug therapy / Q000503:physiopathology*; D009569:Nitric Oxide / Q000032:analysis*; D011239:Prednisolone / Q000627:therapeutic use; D011244:Pregnadienediols / Q000627:therapeutic use; D012137:Respiratory System / Q000378:metabolism; D013147:Spirometry
D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D009569:Nitric Oxide; D011239:Prednisolone