TY - JOUR
T1 - A novel pathophysiologic link between upper and lower airways in patients with chronic rhinosinusitis
T2 - Association of sputum periostin levels with upper airway inflammation and olfactory function
AU - Kanemitsu, Yoshihiro
AU - Suzuki, Motohiko
AU - Fukumitsu, Kensuke
AU - Asano, Takamitsu
AU - Takeda, Norihisa
AU - Nakamura, Yoshihisa
AU - Ozawa, Yoshiyuki
AU - Masaki, Ayako
AU - Ono, Junya
AU - Kurokawa, Ryota
AU - Yap, Jennifer
AU - Nishiyama, Hirono
AU - Fukuda, Satoshi
AU - Ohkubo, Hirotsugu
AU - Maeno, Ken
AU - Ito, Yutaka
AU - Oguri, Tetsuya
AU - Izuhara, Kenji
AU - Takemura, Masaya
AU - Niimi, Akio
N1 - Publisher Copyright:
© 2019 The Author(s)
PY - 2020/1
Y1 - 2020/1
N2 - Background: Chronic rhinosinusitis (CRS) and asthma are collectively called unified airway diseases. Periostin has been implicated in the pathophysiologic link of these conditions but only by serum measurements. We sought to investigate sputum levels of periostin and their association with upper airway inflammation and olfactory function in CRS patients. Methods: We prospectively recruited 56 CRS patients who underwent endoscopic sinus surgery (20 with and 36 without comorbid asthma), and 28 healthy controls between October 2015 and December 2017. Lower and upper airway indices such as sputum periostin levels and eosinophil and neutrophil counts, exhaled fractional nitric oxide (FeNO) levels, and olfactory function were evaluated in the three groups. Radiological severity of CT images and tissue eosinophilia of surgical specimens were also assessed in the CRS patients. Results: Sputum periostin levels were highest, and olfactory function was most impaired, in the CRS patients with comorbid asthma, followed by those without asthma and controls in this order. CRS with asthma group showed higher sputum eosinophils and FeNO levels than the other two groups, while CRS patients without asthma showed significantly higher neutrophils in sputum than the other two groups. When confined to CRS patients, olfactory dysfunction was correlated with sputum eosinophil counts. Eosinophil counts of nasal polyps showed a significant positive correlation with sputum periostin and FeNO levels. Radiological severity of CRS was correlated with sputum eosinophil counts and FeNO levels. Conclusions: Periostin levels and inflammatory cells such as eosinophils and neutrophils in the lower airways are increased in patients with CRS, suggesting the presence of mutual interactions between upper and lower airways even if asthma does not coexist. Olfactory dysfunction and eosinophilic nasal polyps may be potential indicators of Th2-driven inflammation in the lower airways. Trial registration: This study was registered on the UMIN Clinical Trials Registry (Registry ID UMIN000018672).
AB - Background: Chronic rhinosinusitis (CRS) and asthma are collectively called unified airway diseases. Periostin has been implicated in the pathophysiologic link of these conditions but only by serum measurements. We sought to investigate sputum levels of periostin and their association with upper airway inflammation and olfactory function in CRS patients. Methods: We prospectively recruited 56 CRS patients who underwent endoscopic sinus surgery (20 with and 36 without comorbid asthma), and 28 healthy controls between October 2015 and December 2017. Lower and upper airway indices such as sputum periostin levels and eosinophil and neutrophil counts, exhaled fractional nitric oxide (FeNO) levels, and olfactory function were evaluated in the three groups. Radiological severity of CT images and tissue eosinophilia of surgical specimens were also assessed in the CRS patients. Results: Sputum periostin levels were highest, and olfactory function was most impaired, in the CRS patients with comorbid asthma, followed by those without asthma and controls in this order. CRS with asthma group showed higher sputum eosinophils and FeNO levels than the other two groups, while CRS patients without asthma showed significantly higher neutrophils in sputum than the other two groups. When confined to CRS patients, olfactory dysfunction was correlated with sputum eosinophil counts. Eosinophil counts of nasal polyps showed a significant positive correlation with sputum periostin and FeNO levels. Radiological severity of CRS was correlated with sputum eosinophil counts and FeNO levels. Conclusions: Periostin levels and inflammatory cells such as eosinophils and neutrophils in the lower airways are increased in patients with CRS, suggesting the presence of mutual interactions between upper and lower airways even if asthma does not coexist. Olfactory dysfunction and eosinophilic nasal polyps may be potential indicators of Th2-driven inflammation in the lower airways. Trial registration: This study was registered on the UMIN Clinical Trials Registry (Registry ID UMIN000018672).
KW - Asthma
KW - Chronic rhinosinusitis
KW - Eosinophils
KW - Fractional exhaled nitric oxides
KW - Olfactory dysfunction
KW - Periostin
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UR - http://www.scopus.com/inward/citedby.url?scp=85076856713&partnerID=8YFLogxK
U2 - 10.1016/j.waojou.2019.100094
DO - 10.1016/j.waojou.2019.100094
M3 - Article
AN - SCOPUS:85076856713
SN - 1939-4551
VL - 13
JO - World Allergy Organization Journal
JF - World Allergy Organization Journal
IS - 1
M1 - 100094
ER -