title: Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported.
abstract: BACKGROUND
  It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma.
  
  
  OBJECTIVE
  We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii) bronchial inflammation exists in all CRSwNP patients irrespective of clinical asthma status.
  
  
  METHODS
  We collected biopsies from nasal polyps, inferior turbinates and bronchi of 27 CRSwNP patients and 6 controls. All participants were evaluated for lower airway disease according to international guidelines. Inflammatory cytokines were investigated using a Th1/Th2 assay including 14 chemokines and cytokines; tissue concentrations were normalized according to tissue weight and total protein concentration. Individual cytokines and multivariate inflammatory profiles were compared between biopsy sites and between patients and controls.
  
  
  RESULTS
  We found significantly higher concentrations of Th2 cytokines in nasal polyps compared to inferior turbinate and bronchial biopsies. In addition, we showed that the inflammatory profile of nasal polyps and bronchial biopsies correlated significantly (p<0.01). From the Th2 cytokines measured, IL-13 was significantly increased in bronchial biopsies from CRSwNP patients with, but not without asthma.
  
  
  CONCLUSIONS
  Our findings support the united airways concept; however, we did not find evidence for subclinical bronchial inflammation in CRSwNP patients without asthma. Finally, this study indicates for the first time that nasal polyps potentially play an important role in the airway inflammation rather than being a secondary phenomenon.
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Kåre
authors.initials: K
authors.lastname: Håkansson
authors.affiliation: Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium, ENT-Department, Karolinska Institute, Stockholm, Sweden.
authors.forename: Claus
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.affiliation: Department of Respiratory Medicine L, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Simon Francis
authors.initials: SF
authors.lastname: Thomsen
authors.affiliation: Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anders Elm
authors.initials: AE
authors.lastname: Pedersen
authors.affiliation: Department of Biomedical Sciences, Endocrinology Research Section, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Steen Seier
authors.initials: SS
authors.lastname: Poulsen
authors.affiliation: The Bioinformatics Centre (BINF), Department of Biology and Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tomas
authors.initials: T
authors.lastname: Martin-Bertelsen
authors.affiliation: The Bioinformatics Centre (BINF), Department of Biology and Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark; Section for Cognitive Systems, DTU Compute Technical University of Denmark (DTU), Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Winther
authors.affiliation: Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: von Buchwald
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D001706:Biopsy; D016022:Case-Control Studies; D016207:Cytokines / Q000378:metabolism; D004724:Endoscopy; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D012220:Rhinitis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators