Lamblin C, Brichet A, Perez T, Darras J, Tonnel A B, Wallaert B
Clinique des Maladies Respiratoires, Hôpital A. Calmette, CHRU, Lille, France.
Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):406-13. doi: 10.1164/ajrccm.161.2.9905075.
The outcome of asthma and/or nonspecific bronchial hyperresponsiveness (BHR) associated with nasal polyposis (NP) is uncertain. Over a 4-yr period, we investigated the long-term changes of pulmonary function and BHR in 46 patients with NP. Each subject was assessed for nasal symptoms and tested for allergy skin prick tests, serum total IgE, spirometry, and carbachol challenge at baseline before initiating any treatment (T0). Nasal symptoms evaluation, spirometric measurements, and carbachol challenge were repeated at T1 and at T2 (respectively, 12.7 +/- 0.9 and 47.9 +/- 2. 2 mo after T0). In addition, bronchodilator response was measured at T2. At T0, 25 patients exhibited BHR and 16 of 25 were asthmatic. All patients were treated first with topical steroids for 6 wk (beclomethasone 600 microg/d). Eighteen patients were successfully treated with topical steroids (topical steroids responders). Intranasal ethmoidectomy was performed in 28 patients who did not improve with topical steroids alone (topical steroids nonresponders). Nasal score improved at T1 and remained improved at T2 as compared with T0 in both groups (p < 0.005). Topical steroids nonresponders demonstrated a significant decrease of FEV(1), FEV(1)/FVC ratio, and FEF(25-75) at T1 (p < 0.05) and at T2 (p < 0.0005), whereas no significant change was observed in FEV(1) and FEV(1)/FVC ratio in responders. DeltaFEV(1) (%) between T2 and T0 was not related to the presence of asthma, BHR, or atopy. Bronchodilator response at T2 was similar in the two groups. BHR did not significantly change over the 4-yr follow-up period in the two groups. No change in pulmonary symptoms and/or asthma severity occurred. Our results show that nonreversible airflow obstruction appears over a 4-yr follow-up period in topical steroids nonresponders patients with NP requiring nasal surgery. The long-term contribution of these changes to the development of respiratory symptoms in patients with NP remains to be documented.
哮喘和/或与鼻息肉（NP）相关的非特异性支气管高反应性（BHR）的转归尚不确定。在4年的时间里，我们调查了46例NP患者肺功能和BHR的长期变化。在开始任何治疗前的基线期（T0），对每个受试者进行鼻症状评估、变应原皮肤点刺试验、血清总IgE、肺量计检查和卡巴胆碱激发试验。在T1和T2（分别在T0后的12.7±0.9个月和47.9±2.2个月）重复进行鼻症状评估、肺量计测量和卡巴胆碱激发试验。此外，在T2测量支气管扩张剂反应。在T0时，25例患者表现出BHR，其中16例为哮喘患者。所有患者首先接受局部类固醇治疗6周（倍氯米松600μg/d）。18例患者经局部类固醇治疗成功（局部类固醇反应者）。28例仅用局部类固醇治疗效果不佳的患者接受了鼻内筛窦切除术（局部类固醇无反应者）。与T0相比，两组在T1时鼻评分均改善，且在T2时仍保持改善（p<0.005）。局部类固醇无反应者在T1（p<0.05）和T2（p<0.0005）时FEV(1)、FEV(1)/FVC比值和FEF(25 - 75)显著降低，而反应者的FEV(1)和FEV(1)/FVC比值无显著变化。T2和T0之间的DeltaFEV(1)（%）与哮喘、BHR或特应性的存在无关。两组在T2时的支气管扩张剂反应相似。在4年的随访期内，两组的BHR均无显著变化。肺部症状和/或哮喘严重程度无变化。我们的结果表明，在需要鼻手术的NP局部类固醇无反应者患者中，在4年的随访期内出现了不可逆性气流阻塞。这些变化对NP患者呼吸道症状发展的长期影响仍有待记录。
