United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis.
BACKGROUND
Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis.


METHODS
In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO.


RESULTS
Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis.


CONCLUSIONS
The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.
Guilemany
J M
JM
Department of Otorhinolaryngology, Rhinology Unit and Smell Clinic, Pneumology and Respiratory Allergy, Hospital Clnic, University of Barcelona, Spain.
Angrill
J
J
Alobid
I
I
Centellas
S
S
Pujols
L
L
Bartra
J
J
Bernal-Sprekelsen
M
M
Valero
A
A
Picado
C
C
Mullol
J
J
D001987:Bronchiectasis / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D009569:Nitric Oxide / Q000032:analysis; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D012137:Respiratory System / Q000000981:diagnostic imaging / Q000503:physiopathology; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology
D007136:Immunoglobulins; D009569:Nitric Oxide