title: Lower airway inflammation and hyperresponsiveness in non-asthmatic patients with non-allergic rhinitis.
abstract: BACKGROUND
  Potential associations between non-allergic rhinitis (NAR) and asthma have been verified epidemiologically, but these associations remain not very clear. It is necessary to further explore the possible implication of lower airway abnormities in NAR patients but without asthma. This study aims to determine lower airway hyperresponsiveness (AHR), inflammation and lung function in non-asthmatic patients with NAR.
  
  
  METHODS
  We recruited 262 non-asthmatic patients with NAR, 377 with AR and 264 healthy subjects. All subjects were non-smokers who underwent meticulous history taking, nasal examination, allergen skin prick test (SPT), blood routine test, measurement of fractional exhaled nitric oxide (FeNO), methacholine bronchial challenge test and induced sputum eosinophil count, in this order.
  
  
  RESULTS
  Compared with healthy subjects, non-asthmatic patients with NAR yielded markedly lower FEV1/FVC, maximal mid-expiratory flow (MMEF), mid-expiratory flow when 50% of FVC has been expired (MEF50%) and mid-expiratory flow when 75% of FVC has been expired (MEF25%) (P<0.05). Differences in spirometry between group AR and NAR were unremarkable (P>0.05). Patients with NAR yielded higher rate of AHR and higher FeNO levels than healthy subjects but lower than those with AR. The proportion of lower airways disorders (sputum eosinophilia, high FeNO levels or AHR) was highest in group AR (70.8%), followed by NAR (53.4%) and healthy subjects (24.2%) (P<0.01). However, sputum eosinophils in NAR patients were not higher compared with healthy subjects (P>0.05). Sputum eosinophils and FeNO had significant correlation with positive AHR and MMEF in group AR but not in NAR.
  
  
  CONCLUSIONS
  Non-asthmatic patients with NAR harbor lower AHR, small airways dysfunction and inflammation, despite being less significant than those with AR. This offers clues to unravel the link between NAR and asthma.
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Qiuping
authors.initials: Q
authors.lastname: Wang
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Ji
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Xie
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Weijie
authors.initials: W
authors.lastname: Guan
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Kunmin
authors.initials: K
authors.lastname: Wu
authors.affiliation: 1 Department of Otolaryngology and Head Neck Surgery, Jinling Hospital, Nanjing 210002, China ; 2 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Nanshan
authors.initials: N
authors.lastname: Zhong
keywords: Non-allergic rhinitis (NAR); airway hyperresponsiveness (AHR); airway inflammation; allergic rhinitis (AR); asthma