Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center IRCCS, Rozzano, MI Italy.
J Breath Res. 2020 Nov 5;15(1):016007. doi: 10.1088/1752-7163/abc234.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory disease highly impacting patient's quality of life, and associated with lower airway inflammation often evolving into asthma. Exhaled nitric oxide (FE) is a non-invasive tool to assess Type 2 airway inflammation and its extended analysis allows to differentiate between alveolar concentration (CalvNO) and bronchial output (JawNO). It is also possible to assess the sino-nasal production of nitric oxide (nNO). We studied extended nitric oxide production in patients with CRSwNP with or without associated asthma. Consecutive adult patients with CRSwNP, with or without asthma, and 15 healthy controls were enrolled. Exclusion criteria were: smoking, uncontrolled asthma, recent upper or lower airway infections and oral corticosteroid therapy in the 4 weeks preceding clinical evaluation. Patients' demographic and clinical data were collected; patients underwent pulmonary function tests and extended nitric oxide analysis including nasal nNO assessment. A total of 125 subjects were enrolled (15 healthy controls; 69 with CRSwNP and asthma, and 41 with CRSwNP only). FE, JawNO and CalvNO values were higher, while nNO was lower, in all patients with CRSwNP compared to healthy controls; no difference was found in CalvNO between patients with concomitant asthma and non-asthmatic subjects; in asthmatic patients, FE and JawNO were significantly higher, while nNO values was lower, compared to patients with CRSwNP only. These results suggest that CRSwNP could be the first manifestation of a more complex systemic inflammatory pathology driven by Type 2 inflammation. An 'inflammatory gradient' hypothesis could describe a pattern of inflammation in CRSwNP patients that starts distally in the alveoli. Finally, our study indirectly reinforces the concept that novel biological drugs could become valid therapeutic options for nasal polyposis.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种复杂的炎症性疾病，严重影响患者的生活质量，并与下气道炎症相关，后者常发展为哮喘。呼出气一氧化氮（FE）是一种评估 2 型气道炎症的非侵入性工具，其扩展分析可区分肺泡浓度（CalvNO）和支气管输出（JawNO）。还可以评估鼻一氧化氮（nNO）的产生。我们研究了伴有或不伴有相关哮喘的 CRSwNP 患者的扩展一氧化氮产生。连续纳入了伴有或不伴有哮喘的 CRSwNP 成年患者，以及 15 名健康对照者。排除标准为：吸烟、未控制的哮喘、近期上或下呼吸道感染以及在临床评估前 4 周内接受口服皮质类固醇治疗。收集患者的人口统计学和临床数据；患者接受肺功能检查和扩展的一氧化氮分析，包括鼻 nNO 评估。共纳入 125 名受试者（15 名健康对照者；69 名 CRSwNP 伴哮喘，41 名 CRSwNP 仅）。与健康对照组相比，所有 CRSwNP 患者的 FE、JawNO 和 CalvNO 值更高，而 nNO 值更低；在伴哮喘和非哮喘患者之间，CalvNO 无差异；与 CRSwNP 仅患者相比，哮喘患者的 FE 和 JawNO 值显著更高，而 nNO 值更低。这些结果表明，CRSwNP 可能是由 2 型炎症驱动的更复杂全身炎症病理的最初表现。“炎症梯度”假说可以描述 CRSwNP 患者的炎症模式，该模式从肺泡远端开始。最后，我们的研究间接强化了这样一种概念，即新型生物药物可能成为鼻息肉治疗的有效治疗选择。
