Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis.
OBJECTIVE
Eosinophilic chronic rhinosinusitis (ECRS) is as a subgroup of chronic rhinosinusitis (CRS) with nasal polyps. ECRS is a refractory disease closely related to bronchial asthma. Fractionated exhaled nitric oxide (FeNO) levels were reportedly elevated in some asthmatics with CRS after adequate treatment, suggesting that residual eosinophilic airway inflammation or ECRS might affect FeNO levels.


METHODS
To investigate the association between asthma with ECRS and FeNO levels, we examined FeNO levels in 133 asthmatics (99 with ECRS and 34 without ECRS) and 13 patients with ECRS without asthma. The severity of asthma was defined by the Global Initiative for Asthma guidelines and that of sinusitis was evaluated by the sinus CT score based on the Lund-Mackay scale.


CONCLUSIONS
FeNO levels were elevated even in well-controlled asthmatics with ECRS, whereas asthmatics without ECRS and ECRS patients without asthma did not have high FeNO levels (>50 ppb). Although FeNO levels were not correlated with asthma severity, they were positively correlated with the sinus CT score. In asthmatics with ECRS, patients with higher FeNO levels had more severe ECRS and asthma. There is a possibility of having comorbid ECRS, particularly in asthmatics with high FeNO levels even after adequate treatment, including ICS, suggesting that asthma and ECRS may be closely associated as one airway disease with eosinophilic inflammation. Continual awareness of the coexistent ECRS is ideally recommended for asthmatics with high FeNO levels.
a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.|b Department of Airway Medicine , Mitsubishi Kyoto Hospital , Kyoto , Japan.
Yoshiki
Y
Kobayashi
a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.
Mikiya
M
Asako
a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.
Hisashi
H
Ooka
a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.
Akira
A
Kanda
a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.
Koichi
K
Tomoda
b Department of Airway Medicine , Mitsubishi Kyoto Hospital , Kyoto , Japan.
Hirotaka
H
Yasuba
D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism*; D001944:Breath Tests; D002908:Chronic Disease; D004802:Eosinophilia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps; D009569:Nitric Oxide / Q000032:analysis*; D012220:Rhinitis / Q000453:epidemiology*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000453:epidemiology*
D009569:Nitric Oxide
Airway medicine; ECRS; FeNO; bronchial asthma; exhalation though the nose; united airway