DOI QR코드

DOI QR Code

Association of nasal inflammation and lower airway responsiveness in schoolchildren based on an epidemiological survey

  • Myung, Jun-Ho (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Seo, Hyun-Jeong (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Soo-Jeong (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Bo-Young (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Shin, Il-Sang (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jang, Jun-Hak (Department of Nursing, Montana State University) ;
  • Kim, Yun-Kyung (Department of Nursing, Gwangju Workers' Health Center) ;
  • Jang, An-Soo (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital)
  • Received : 2013.08.12
  • Accepted : 2013.10.28
  • Published : 2015.03.01

Abstract

Background/Aims: We sought to increase our understanding of the rhinitis-asthma relationship and improve strategies for the treatment of patients with these diseases. The aim of this study was to identify a connection between upper airway inflammation and lower airway responsiveness. Methods: We counted eosinophils on nasal smears, and performed spirometry, allergic skin tests, and methacholine challenge tests in 308 schoolchildren plus a questionnaire on respiratory symptoms. The methacholine concentration causing a 20% fall in forced expiratory volume in 1 second ($PC_{20}$ < 25 mg/mL) was used as the threshold of bronchial hyperresponsiveness (BHR). Results: In total, 26% of subjects had positive nasal eosinophils on a smear, and 46.2% of subjects had BHR at < 25 mg/mL methacholine $PC_{20}$. Nasal symptoms were higher in subjects with than without nasal eosinophils (p = 0.012). Asthma symptoms did not differ between subjects with and without nasal eosinophils. Nasal eosinophils were higher in subjects with atopy than those without (p = 0.006), and there was no difference in $PC_{20}$ methacholine according to atopy ($15.5{\pm}1.07$ vs. $17.5{\pm}0.62$; p > 0.05). No difference in BHR was detected when comparing subjects with and without nasal eosinophils. There were significant differences in the $PC_{20}$ between subjects with greater than 50% nasal eosinophils and without nasal eosinophils ($11.01{\pm}2.92mg/mL$ vs. $17.38{\pm}0.61mg/mL$; p < 0.001). Conclusions: These findings demonstrated that nasal eosinophilic inflammation might contribute to lower airway responsiveness in schoolchildren, based on an epidemiological survey.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF), Soonchunhyang University

References

  1. Braunstahl GJ. United airways concept: what does it teach us about systemic inflammation in airways disease? Proc Am Thorac Soc 2009;6:652-654. https://doi.org/10.1513/pats.200906-052DP
  2. Leynaert B, Neukirch C, Kony S, et al. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol 2004;113:86-93. https://doi.org/10.1016/j.jaci.2003.10.010
  3. Ciprandi G, Cirillo I. The lower airway pathology of rhinitis. J Allergy Clin Immunol 2006;118:1105-1109. https://doi.org/10.1016/j.jaci.2006.05.010
  4. Townley RG, Ryo UY, Kolotkin BM, Kang B. Bronchial sensitivity to methacholine in current and former asthmatic and allergic rhinitis patients and control subjects. J Allergy Clin Immunol 1975;56:429-442. https://doi.org/10.1016/0091-6749(75)90061-5
  5. Madonini E, Briatico-Vangosa G, Pappacoda A, Maccagni G, Cardani A, Saporiti F. Seasonal increase of bronchial reactivity in allergic rhinitis. J Allergy Clin Immunol 1987;79:358-363. https://doi.org/10.1016/0091-6749(87)90156-4
  6. Jang AS. Nasal eosinophilic inflammation contributes to bronchial hyperresponsiveness in patients with allergic rhinitis. J Korean Med Sci 2002;17:761-764. https://doi.org/10.3346/jkms.2002.17.6.761
  7. Ramsdale EH, Morris MM, Roberts RS, Hargreave FE. Asymptomatic bronchial hyperresponsiveness in rhinitis. J Allergy Clin Immunol 1985;75:573-577. https://doi.org/10.1016/0091-6749(85)90032-6
  8. Jang AS, Choi IS. Eosinophil activation markers in induced sputum in asthmatics. Korean J Intern Med 2000;15:1-7. https://doi.org/10.3904/kjim.2000.15.1.1
  9. Corren J. The impact of allergic rhinitis on bronchial asthma. J Allergy Clin Immunol 1998;101(2 Pt 2):S352-S356. https://doi.org/10.1016/S0091-6749(98)70218-0
  10. Gutierrez V, Prieto L, Torres V, Morales C, Gonzalez E. Peak flow variability and sputum eosinophilia in allergic rhinitis. Ann Allergy Asthma Immunol 1998;81:143-150. https://doi.org/10.1016/S1081-1206(10)62801-3
  11. Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J 1995;8:483-491. https://doi.org/10.1183/09031936.95.08030483
  12. Meltzer EO, Jalowayski AA. Nasal cytology in clinical practice. Am J Rhinol 1988;2:47-54. https://doi.org/10.2500/105065888781693212
  13. Statement of the American Thoracic Society. Standardization of spirometry: 1987 update. Am Rev Respir Dis 1987;136:1285-1298. https://doi.org/10.1164/ajrccm/136.5.1285
  14. Morris AH, Kanner RE, Crapo RO, Gerdner RM. Clinical Pulmonary Function Testing: A Manual of Uniform Laboratory Procedures. 2nd ed. Salt Lake City: Intermountain Thoracic Society, 1984.
  15. Choi IS, Kim JM, Park JO, Park KO. Normal standards of the maximal expiratory flow: volume curve for healthy nonsmoking adults. Korean J Med 1984;27:192-200.
  16. Chai H, Farr RS, Froehlich LA, et al. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol 1975;56:323-327. https://doi.org/10.1016/0091-6749(75)90107-4
  17. Hellings PW, Hens G. Rhinosinusitis and the lower airways. Immunol Allergy Clin North Am 2009;29:733-740. https://doi.org/10.1016/j.iac.2009.08.001
  18. Hellings PW, Prokopakis EP. Global airway disease beyond allergy. Curr Allergy Asthma Rep 2010;10:143-149. https://doi.org/10.1007/s11882-010-0107-1
  19. Simons FE. Allergic rhinobronchitis: the asthma-allergic rhinitis link. J Allergy Clin Immunol 1999;104(3 Pt 1):534-540. https://doi.org/10.1016/S0091-6749(99)70320-9
  20. Bugiani M, Carosso A, Migliore E, et al. Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy. Allergy 2005;60:165-170. https://doi.org/10.1111/j.1398-9995.2005.00659.x
  21. Downie SR, Andersson M, Rimmer J, et al. Association between nasal and bronchial symptoms in subjects with persistent allergic rhinitis. Allergy 2004;59:320-326. https://doi.org/10.1111/j.1398-9995.2003.00419.x
  22. Braman SS, Barrows AA, DeCotiis BA, Settipane GA, Corrao WM. Airway hyperresponsiveness in allergic rhinitis: a risk factor for asthma. Chest 1987;91:671-674. https://doi.org/10.1378/chest.91.5.671
  23. Ciprandi G, Cirillo I, Vizzaccaro A, et al. Seasonal and perennial allergic rhinitis: is this classification adherent to real life? Allergy 2005;60:882-887. https://doi.org/10.1111/j.1398-9995.2005.00602.x
  24. Church MK, Levi-Schaffer F. The human mast cell. J Allergy Clin Immunol 1997;99:155-160. https://doi.org/10.1016/S0091-6749(97)70089-7
  25. Borish L, Rosenwasser LJ. Update on cytokines. J Allergy Clin Immunol 1996;97:719-733. https://doi.org/10.1016/S0091-6749(96)80146-1
  26. Barnes PJ. Cytokines as mediators of chronic asthma. Am J Respir Crit Care Med 1994;150(5 Pt 2):S42-S49. https://doi.org/10.1164/ajrccm/150.5_Pt_2.S42
  27. Ciprandi G, Cirillo I, Vizzaccaro A, Milanese M, Tosca MA. Airway function and nasal inflammation in seasonal allergic rhinitis and asthma. Clin Exp Allergy 2004;34:891-896. https://doi.org/10.1111/j.1365-2222.2004.01970.x
  28. Ciprandi G, Cirillo I, Vizzaccaro A, Milanese M, Tosca MA. Correlation of nasal inflammation and nasal airflow with forced expiratory volume in 1 second in patients with perennial allergic rhinitis and asthma. Ann Allergy Asthma Immunol 2004;93:575-580. https://doi.org/10.1016/S1081-1206(10)61266-5
  29. Ciprandi G, Vizzaccaro A, Cirillo I, Tosca M, Massolo A, Passalacqua G. Nasal eosinophils display the best correlation with symptoms, pulmonary function and inflammation in allergic rhinitis. Int Arch Allergy Immunol 2005;136:266-272. https://doi.org/10.1159/000083953
  30. Marseglia GL, Cirillo I, Vizzaccaro A, et al. Role of forced expiratory flow at 25-75% as an early marker of small airways impairment in subjects with allergic rhinitis. Allergy Asthma Proc 2007;28:74-78. https://doi.org/10.2500/aap.2007.28.2920
  31. Eggleston PA. Upper airway inflammatory diseases and bronchial hyperresponsiveness. J Allergy Clin Immunol 1988;81(5 Pt 2):1036-1041. https://doi.org/10.1016/0091-6749(88)90176-5

Cited by

  1. Aggravation of airway inflammation and hyper‐responsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma vol.71, pp.3, 2015, https://doi.org/10.1111/all.12808
  2. School Absenteeism Associated with Asthma and Allergic Diseases in Korean School-Aged Children vol.31, pp.3, 2015, https://doi.org/10.1089/ped.2017.0835
  3. Impact of Allergic Rhinitis on Nasal Mucociliary Clearance Time in Children vol.179, pp.4, 2015, https://doi.org/10.1159/000499740
  4. Effect of spirometry on exhaled nitric oxide values in asthmatic children vol.30, pp.6, 2015, https://doi.org/10.1111/pai.13086