Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis

Kobayashi, Yoshiki; Asako, Mikiya; Ooka, Hisashi; Kanda, Akira; Tomoda, Koichi; Yasuba, Hirotaka

doi:10.3109/02770903.2015.1054404

Cited by 27 publications

(20 citation statements)

References 20 publications

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“…Likewise, ECRS, similar to AR, contributes to T helper 2 (Th2)-skewed pathology and is strongly associated with severe asthma [11,13]. Indeed, we have reported that fractionated exhaled nitric oxide reflective of disturbance of lung function was correlated with sinus computed tomography (CT) score based on the Lund–Mackay scale [16].…”

Section: Etiology Of United Airway Diseasementioning

confidence: 99%

Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

et al. 2019

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The concept of united airway disease comprises allergic rhinitis (AR) with asthma, and eosinophilic chronic rhinosinusitis (ECRS) with asthma. It embodies a comprehensive approach to the treatment of upper and lower airway inflammation. The treatment of upper airway inflammation reduces asthma symptoms and decreases the dose of inhaled corticosteroids (ICS) necessary to treat asthma. However, little is known about the mechanisms of interaction between upper and lower airway inflammation. Here we review these mechanisms, focusing on neural modulation and introduce a novel therapeutic approach to united airway disease using a fine-particle ICS. Our understanding of the relationship between the upper and lower airways and its contribution to T helper 2 (Th2)-skewed disease, such as AR and/or ECRS with asthma, has led us to this novel therapeutic strategy for a comprehensive approach to the treatment of upper airway inflammation with asthma.

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Section: Etiology Of United Airway Diseasementioning

confidence: 99%

Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

et al. 2019

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“…Approximately half of the patients with ECRS have bronchial asthma ( 3 ), which is a risk factor of relapse after endoscopic sinus surgery ( 4 ). Furthermore, in those with severe ECRS, asthma is significantly associated with ECRS in more than 80% of cases ( 4 , 5 ). Conversely, a recent report suggests that more than 50% of patients with severe asthma also had ECRS ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

HFA-BDP Metered-Dose Inhaler Exhaled Through the Nose Improves Eosinophilic Chronic Rhinosinusitis With Bronchial Asthma: A Blinded, Placebo-Controlled Study

et al. 2018

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Background: Eosinophilic chronic rhinosinusitis (ECRS) is a subtype of chronic rhinosinusitis with nasal polyps in Japanese. ECRS highly associated with asthma is a refractory eosinophilic airway inflammation and requires comprehensive care as part of the united airway concept. We recently reported a series of ECRS patients with asthma treated with fine-particle inhaled corticosteroid (ICS) exhalation through the nose (ETN).Objective: To evaluate fine-particle ICS ETN treatment as a potential therapeutic option in ECRS with asthma.Methods: Twenty-three patients with severe ECRS under refractory to intranasal corticosteroid treatment were randomized in a double-blind fashion to receive either HFA-134a-beclomethasone dipropionate (HFA-BDP) metered-dose inhaler (MDI) ETN (n = 11) or placebo MDI ETN (n = 12) for 4 weeks. Changes in nasal polyp score, computed tomographic (CT) score, smell test, and quality of life (QOL) score from baseline were assessed. Fractionated exhaled nitric oxide (FENO) was measured as a marker of eosinophilic airway inflammation. Response to corticosteroids was evaluated before and after treatment. Additionally, deposition of fine-particles was visualized using a particle deposition model. To examine the role of eosinophils on airway inflammation, BEAS-2B human bronchial epithelial cells were co-incubated with purified eosinophils to determine corticosteroid sensitivity.Results: HFA-BDP MDI ETN treatment improved all assessed clinical endpoints and corticosteroid sensitivity without any deterioration in pulmonary function. FENO and blood eosinophil number were reduced by HFA-BDP MDI ETN treatment. The visualization study suggested that ETN at expiratory flow rates of 10–30 L/min led to fine particle deposition in the middle meatus, including the sinus ostia. Co-incubation of eosinophils with BEAS-2B cells induced corticosteroid resistance.Conclusions: Additional HFA-BDP MDI ETN treatment was beneficial in patients with ECRS and should be considered as a potential therapeutic option for eosinophilic airway inflammation such as ECRS with asthma. (UMIN-CTR: R000019325) (http://www.umin.ac.jp/ctr/index.htm).

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“…Effects of comorbid asthma and ESS on type 2-driven inflammation in CRS patients have been reported by using blood eosinophil, serum periostin, and FeNO [20, 24-26, 37, 39-41]. Serum periostin levels are significantly increased in asthmatics by having comorbid CRS [20, 24, 25], along with blood eosinophils [26] and FeNO [25, 26, 40].…”

Section: Discussionmentioning

confidence: 99%

“…Serum periostin levels are significantly increased in asthmatics by having comorbid CRS [20, 24, 25], along with blood eosinophils [26] and FeNO [25, 26, 40]. Also, increased FeNO levels were correlated with radiological CRS severity in ECRS patients [37, 39]. We have already demonstrated that blood eosinophils, serum periostin, and FeNO are applicable for use in distinguishing comorbid CRS among patients with asthma [25].…”

Section: Discussionmentioning

confidence: 99%

Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients

Kanemitsu

Kurokawa

Ono³

et al. 2020

Int Arch Allergy Immunol

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Background: Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases. Objective: To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients. Methods: We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated. Results: Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (p < 0.01 for all) and discriminated comorbid asthma among CRS patients (p < 0.05; AUC > 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = −0.49, p = 0.03) and its relative reduction after ESS (ρ = 0.53, p = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations. Conclusion: Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma.

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Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis

Cited by 27 publications

References 20 publications

Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

HFA-BDP Metered-Dose Inhaler Exhaled Through the Nose Improves Eosinophilic Chronic Rhinosinusitis With Bronchial Asthma: A Blinded, Placebo-Controlled Study

Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients

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