The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma.

OBJECTIVES/HYPOTHESIS: To investigate the role of airway patency and factors associated with airway patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma.

STUDY DESIGN: Retrospective study.

METHODS: The upper and lower airway patency of 140 patients with CRSwNP and asthma (asthma group) and 42 patients with CRSwNP without asthma (nonasthma control group) was measured using acoustic rhinometry, rhinomanometry, and spirometry. Total serum immunoglobulin E and eosinophil counts were also compared. The severity of nasal diseases in these patients was assessed via the Lund-Mackay score (LMS) and Lund-Kennedy score (LKS).

RESULTS: There was no difference between the asthma and nonasthma groups in terms of total nasal resistance at 75 Pa (R(75T)), bilateral minimum cross-sectional area (MCA(R+L)), or bilateral nasal cavity volume between 0 and 7.0 cm(3) (V7(R+L)). Forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75)) of the asthma group were significantly lower than those of the nonasthma group. FEV(1) and FEF(25-75) were not correlated with R(75T), MCA(R+L), V7(R+L), or severity of nasal disease. For the patients with asthma, LMS and serum eosinophil counts were independent predictors of MCA(R+L).

CONCLUSIONS: The presence of asthma may not influence upper airway patency in CRSwNP patients. In CRSwNP patients with asthma, impairment of upper airway patency was associated with changes in LMS and eosinophilia, and in these patients lower airway patency was significantly lower than that of the control group (without asthma). In CRSwNP patients with asthma, there was little or no association between upper and lower airway patency.