Determinants of Exhaled Nitric Oxide in Chronic Rhinosinusitis

Guida, Giuseppe; Rolla, Giovanni; Badiu, Iuliana; Marsico, Pietro; Pizzimenti, Stefano; Bommarito, Luisa; Stefani, A. De; Usai, Antonio; Bugiani, Massimiliano; Malinovschi, Andreï; Bucca, Caterina; Heffler, Enrico

doi:10.1378/chest.09-0667

Cited by 51 publications

(38 citation statements)

References 32 publications

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“…Eosinophil counts of sputum were higher in ECRS patients than in non-ECRS patients when only patients without asthma were tested (data not shown). Consistent with previous reports [12,13], all of these findings suggest that ECRS but not non-ECRS patients had lower airway inflammation. …”

Section: Discussionsupporting

confidence: 92%

Lower Airway Inflammation in Eosinophilic Chronic Rhinosinusitis as Determined by Exhaled Nitric Oxide

Kambara¹,

Minami

Akazawa

et al. 2017

Int Arch Allergy Immunol

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Background: Chronic rhinosinusitis (CRS) is classified into eosinophilic CRS (ECRS) and non-ECRS. The objectives of this study were to evaluate lower airway inflammation by measuring the fractional concentration of exhaled nitric oxide (FeNO) and to examine the effects of endoscopic sinus surgery (ESS) on FeNO in patients with ECRS compared to non-ECRS. Methods: CRS patients with nasal polyps (23 with ECRS and 22 with non-ECRS) were enrolled into this study. ECRS was diagnosed based on the definition proposed by the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) study group. Several clinical markers including blood eosinophil counts, percent of eosinophils in white blood cells (WBC), number of eosinophils in nasal polyps, JESREC scores, total IgE, FeNO, and Lund-Mackay paranasal sinus CT scores were compared between ECRS and non-ECRS. These markers were also tested before and 2 months after ESS. Results: FeNO was significantly higher in patients with ECRS than in non-ECRS patients. When all CRS patients were tested, a significant correlation was found between FeNO and eosinophilic markers including blood eosinophil counts, percent of eosinophils in WBC, number of eosinophils in nasal polyps, and JESREC scores. FeNO showed a significant correlation with Lund-Mackay scores only in ECRS patients. Blood eosinophil counts, percent of eosinophils in WBC, and FeNO decreased after ESS only in ECRS patients. Conclusions: ECRS patients had lower airway inflammation as revealed by an elevated FeNO, which was parallel to the Lund-Mackay CT scores. ESS decreased the blood eosinophils and FeNO, leading to an improvement of the occult pulmonary dysfunction in ECRS patients.

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Section: Discussionsupporting

confidence: 92%

Lower Airway Inflammation in Eosinophilic Chronic Rhinosinusitis as Determined by Exhaled Nitric Oxide

Kambara¹,

Minami

Akazawa

et al. 2017

Int Arch Allergy Immunol

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“…Our definition of CRS, which included both sinus changes and nasal polyps, may have led to the association we observed. Indeed, a recent study showed that increased FENO is more frequent in CRS with nasal polyps compared with CRS without nasal polyps . Moreover, in our study, the mean number of blood eosinophils was significantly higher for subjects with CRS than that for subjects without CRS ( P < 0.0001), even though 62% of the latter group had allergic rhinitis (data not shown).…”

Section: Discussionsupporting

confidence: 48%

Associated demographics of persistent exhaled nitric oxide elevation in treated asthmatics

Matsunaga

Yanagisawa

Hirano

et al. 2012

Clin Experimental Allergy

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Background The fraction of exhaled nitric oxide (FENO) is reduced by anti-inflammatory treatment in asthma. However, the FENO level is also regulated by individual demographics and there is considerable variation among clinically stable patients. Objective We hypothesized that some demographics may be responsible for persistent FENO elevation despite inhaled corticosteroids (ICS) therapy in asthma. Methods This was a prospective observational study. We initially screened 250 stable asthmatics and determined the FENO cut-off point for identifying poorly controlled asthma defined by one of the following criteria: Asthma control test <20, or forced expiratory volume in one-second % of predicted <80%, or peak expiratory flow variability <80% (Study 1). After 12-weeks, 229 patients who maintained high or low FENO were selected and the independent factors which might contribute to a high FENO were examined (Study 2). Results A FENO level >39.5 p.p.b. yielded 67% sensitivity and 76% specificity for identifying the patients with poorly controlled asthma. The persistent high FENO group (40 p. p.b.) was more likely to be ex-smokers, to show evidence of atopy (positive specific IgE, higher serum IgE and blood eosinophils), and to have allergic comorbidities. Especially, past smoking history, blood eosinophils, and chronic rhinosinusitis were identified to be independent predictors of high FENO. Neither the dose of ICS nor other medication use showed any difference between the groups. Conclusions and Clinical Relevance These results suggested that past smoking history, blood eosinophilia, and chronic rhinosinusitis are involved in the persistent airway inflammation detected by FENO. Although their relative contributions on FENO values should be further quantified, clarification of the features of the subjects with high FENO might provide clues for adjustment of the treatment approach in asthma.

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“…It is well known that persistent airway inflammation may be observed also in patients with asymptomatic asthma [26] possibly leading to airway remodeling and fixed bronchial obstruction [27]. It is interesting that most of these patients have CRSwNP, comorbidity which has been related to eosinophilic airway inflammation [28].…”

Section: Discussionmentioning

confidence: 99%

Nasal nitric oxide is a marker of poor asthma control

Heffler¹,

Pizzimenti²,

Badiu³

et al. 2013

J. Breath Res.

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Asthma control, evaluated by symptoms, exacerbations rate and lung function may be greatly influenced by comorbidities, particularly chronic rhinosinusitis (CRS). Measurement of nasal nitric oxide (nNO) is a simple way to assess the severity of CRS. We aimed to analyze the relationship between asthma control and nasal NO. All patients with moderate-to-severe asthma on regular follow-up at our Outpatients' Clinic between November 2009 and April 2010 were included into the study. All patients were evaluated for asthma control by asthma control questionnaire (ACQ) and comorbidities (rhinitis, chronic rhinosinusitis with (CRSwNP) or without nasal polyps, obesity). Exhaled nitric oxide and nNO were obtained in all patients. Eighty-two patients were enrolled (mean age: 48 years, range: 21-80; 42 females). According to ACQ, 53 patients (64.6%) reported controlled asthma. Patients with uncontrolled asthma had lower nNO and higher prevalence of CRSwNP, with a significant correlation between nNO and ACQ. nNO is a biomarker negatively related to asthma control. As low nNO values were associated to CRSwNP, our results indicate that asthma control is highly influenced by this comorbidity.

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Determinants of Exhaled Nitric Oxide in Chronic Rhinosinusitis

Cited by 51 publications

References 32 publications

Lower Airway Inflammation in Eosinophilic Chronic Rhinosinusitis as Determined by Exhaled Nitric Oxide

Lower Airway Inflammation in Eosinophilic Chronic Rhinosinusitis as Determined by Exhaled Nitric Oxide

Associated demographics of persistent exhaled nitric oxide elevation in treated asthmatics

Nasal nitric oxide is a marker of poor asthma control

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