Nasal Airflow Measured by Rhinomanometry Correlates with FeNO in Children with Asthma

Abstract

BackgroundRhinitis and asthma share similar immunopathological features. Rhinomanometry is an important test used to assess nasal function and spirometry is an important tool used in asthmatic children. The degree to which the readouts of these tests are correlated has yet to be established. We sought to clarify the relationship between rhinomanometry measurements, fractional exhaled nitric oxide (FeNO), and spirometric measurements in asthmatic children.MethodsPatients’ inclusion criteria: age between 5 and 18 years, history of asthma with nasal symptoms, and no anatomical deformities. All participants underwent rhinomanometric evaluations and pulmonary function and FeNO tests.ResultsTotal 84 children were enrolled. By rhinomanometry, the degree of nasal obstruction was characterized as follows: (1) no obstruction in 33 children, (2) slight obstruction in 29 children, and (3) moderate obstruction in 22 children. FeNO was significantly lower in patients without obstruction than those with slight or moderate obstruction. Dividing patients according to ATS Clinical Practice Guidelines regarding FeNO, patients < 12 years with FeNO > 20 ppb had a lower total nasal airflow rate than those with FeNO < 20 ppb. Patients ≥ 12 years with FeNO > 25 ppb had a lower total nasal airflow rate than those with FeNO < 25 ppb.ConclusionsHigher FeNO was associated with a lower nasal airflow and higher nasal resistance. This supports a relationship between upper and lower airway inflammation, as assessed by rhinomanometry and FeNO. The results suggest that rhinomanometry may be integrated as part of the functional assessment of asthma.

Dependence of Anterior Active Rhinomanometry Indices on Nasal Obstructive Disorders in Children with Atopic Bronchial Asthma Complicated by Nasal Symptoms

“…At present, there are studies that characterize rhinomanometric indicators in children in selected populations [ 27 – 29 ], but unified recommendations for evaluating AARM parameters in children have not been developed to date [ 13 ]. At the same time, in studies of Chen et al [ 9 ] and Julia et al [ 28 ], the relationship between the results of AARM and the anthropometric parameters of children was noted. According to [ 9 ], as the child grows, the size of the nasal cavity increases, which causes an increase in nasal airflow.…”

“…The widespread usage of AARM in the clinical practice is hampered, among other factors, by the lack of information on the dependence of the AARM results on the comorbid pathologies and variation of anthropometric characteristic of patients and their conditions. Probably, this explains the lack of this method in the list of recommendations for managing patients with AR [ 9 , 15 ].…”

“…There are only few studies of nasal patency evaluation with the objective methods in asthmatic patients [ 9 , 16 ]. They demonstrate the mutual influence of respiratory patency of the upper and lower airways [ 16 ].…”

“…We have not found any studies where objective assessment of the effect of NOD on nasal flow parameters in children with asthma compared with patients without NOD would be made. In particular, in the study of Chen et al [ 9 ], the AARM method was used to study nasal patency in children with asthma and nasal symptoms, but patients with anatomical deformations of upper airways were excluded from the study cohort. At the same time, according to our data, up to 50% of children with asthma and nasal symptoms have such deformations [ 2 , 7 ].…”

The Role of the Depressor Nasi Septi Muscle in Nasal Air Flow

“…Nasal airflow resistance was evaluated based on active anterior RMM measurements. All measurements were performed by a single otolaryngologist from the Otorhinolaryngology Department of Cerrahpasa Medical Faculty, Istanbul University, at a steady pressure of 150 Pa, as recommended by the European Rhinomanometry Standardization Committee [17,18]. Nasal airflow resistance was evaluated based on active anterior RMM measurements.…”