Clinical and pathological characteristics of CRS with nasal polyps in patients with asthma-COPD overlap.

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Basophils are elevated in nasal polyps of patients with chronic rhinosinusitis without aspirin sensitivity

Advances in upper airway diseases and allergen immunotherapy

Asthma (AS) and allergic rhinitis (AR) are the two most common comorbidities for chronic rhinosinusitis with nasal polyps (NP). This study aims to compare the different impacts of AS and AR on NP, including disease severity, inflammatory profiles, and surgical outcomes. The retrospective study enrolled NP patients who underwent endoscopic sinus surgery and 12 months follow-up. They were categorized into four groups based on the presence of AS and/or AR: NP with AS and AR (NP + AS+AR); NP with AS only (NP + AS); NP with AR only (NP + AR); NP without AS and AR (NP-alone). Preoperative and postoperative measures included Lund-Mackay (LM) score, TNSS, VAS, SNOT-22, and postoperative endoscopic score (E-score). Blood and tissue eosinophil (Eos) conditions and protein levels of inflammatory cytokines in NP tissue were measured. A total of 185 NP patients were included. Compared to NP-alone patients, NP + AS + AR and NP + AS had higher uncontrolled rates (p < 0.05). At baseline, NP + AS had higher SNOT-22, VAS of olfactory, LM scores, blood and tissue Eos count, and proportion of ECRS than NP-alone (p < 0.05). After surgery, NP + AS still had higher SNOT-22 and worse E-score than NP-alone (p < 0.05). In contrast, the NP + AR group only had worse VAS of olfactory than NP-alone before surgery (p < 0.05), but did not differ from NP-alone in other aspects mentioned above. After Multivariate Logistic regression analysis, AS was the risk factor for CRS uncontrol status and ECRS (p < 0.05). The uncontrolled status in NP patients is significantly affected by comorbid AS but not AR. Both AS and AR may also affect NP disease severity and the degree of eosinophilic inflammation, while the former may be significantly serious.

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Do we really need asthma–chronic obstructive pulmonary disease overlap syndrome?

Sex-Specific Differences In Disease Severity In Patients With Chronic Rhinosinusitis With Nasal Polyps

Objective:To analyze the differential expression of neural precursor cell-expressed developmentally downregulated 8（NEDD8） protein in nasal polyp tissues of patients with different pathological types of chronic rhinorhinosinusitis with nasal polyps（CRSwNP）. Methods:All specimens were obtained from the specimen library of Beijing Tongren Hospital, and were all patients who underwent nasal endoscopic surgery for chronic rhinosinusitis in Beijing Tongren Hospital. Hematoxylin-eosin staining（HE） was used to detect the number of eosinophils in nasal polyps, and CRSwNP patients were grouped according to the number of eosinophils in nasal polyps, immunohistochemistry was used to detect and analyze the expression level of NEDD8 protein in nasal polyps. Results:The expression level of NEDD8 protein in nasal polyps of patients with eosinophilic chronic rhinorhinosinusitis with nasal polyps was significantly higher than that of patients with non-eosinophilic chronic rhinosinusitis and nasal polyps（P<0.05）. In addition, there was a significant positive correlation between the expression level of NEDD8 protein and the number of eosinophils in nasal polyp tissue（r=0.79, P=0.02）. Conclusion:There are differences in the expression of NEDD8 protein in patients with chronic rhinosinusitis and nasal polyps of different pathological types.

Objective: To explore the expression of amphiregulin (AREG) in nasal polyps patients with different degrees of eosinophil infiltration, and to analyze the correlation between AREG and tissue remodeling. Methods: Forty-eight patients underwent endoscopic sinus surgery in the Department of Otorhinolaryngology Head and Neck Surgery, Remin Hospital, Wuhan University from July 2017 to August 2018 were recruited, including 40 males and 8 females, aged from 16 to 60 years old. The subjects were divided into three groups: control group (n=14), eosinophilic chronic sinusitis with nasal polyps (ECRSwNP) group (n=19) and noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group (n=15). The relative expression of AREG in nasal mucosa was detected by Western blot assay and immunohistochemical staining. Tissue remodeling was detected by HE staining, AB-PAS staining and Masson staining. Kruskal-Wallis test was used for comparison among multiple groups, and Spearman correlation analysis was conducted between the expression level of AREG and the related indexes of tissue remodeling. Results: The expression of AREG in ECRSwNP group was significantly higher than that in non-ECRSwNP group and control group (median protein expression of Western blot was 1.592 vs 0.617 vs0.582, all P<0.05). The degree of epithelial injury and goblet cell metaplasia in ECRSwNP group was significantly higher than that in control group (all P<0.05), the percentage of collagen fibrosis area in ECRSwNP group was significantly lower than that in control group (P=0.01). In chronic rhinosinusitis with nasal polyps (CRSwNP) patients, the area of mucous glands was negatively correlated with the expression of AREG (r=-0.616, P<0.05), and the percentage of collagen fibrosis area was negatively correlated with the expression of AREG (r=-0.738, P<0.05). Conclusion: The expression of AREG is higher in ECRSwNP patients, which is related to the process of tissue remodeling.

New asthma testing enhances the care of respiratory patients

Heterogeneous inflammatory patterns in chronic rhinosinusitis without nasal polyps in Chicago, Illinois

An important percentage of subjects diagnosed with chronic upper airway disease report alcohol-induced worsening of their symptoms. The prevalence and characteristics of respiratory reactions provoked by alcohol-containing drinks have not been fully investigated yet. The aim of this study was to estimate the prevalence and characteristics of alcohol hyper-responsiveness in patients with chronic airway disease and healthy controls. Furthermore, nasal inflammation was evaluated in nasal polyp patients with and without hyper-responsiveness. We evaluated the prevalence and characteristics of alcohol-induced respiratory complaints in 1281 subjects. Chronic rhinosinusitis with nasal polyps (CRSwNP) patients with and without NSAID exacerbated respiratory disease (NERD), chronic rhinosinusitis patients without nasal polyps (CRSsNP), allergic rhinitis (AR) patients and healthy controls were approached by means of a questionnaire. Inflammatory markers (eosinophilic cationic protein (ECP), IL-5, IgE, SAE-specific IgE, IL-17, TNFα and IFNγ) in tissue were then compared between alcohol hyper-responsive and non-hyper-responsive CRSwNP patients. The highest prevalence of nasal and bronchial alcohol hyper-responsiveness was observed in patients with NERD, followed by CRSwNP, and less frequent in CRSsNP, AR and healthy controls. Alcohol hyper-responsiveness is significantly more prevalent in CRSwNP patients suffering from recurrent disease and in patients with severe symptomatology. In nasal tissue of the hyper-responsive CRSwNP group, we observed significantly higher nasal levels of the eosinophilic biomarker ECP. Nasal hyper-responsiveness to alcohol is significantly more prevalent in severe eosinophilic upper airway disease.

Increased expression of the epithelial anion transporter pendrin/SLC26A4 in nasal polyps of patients with chronic rhinosinusitis

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Nose and lung, two of a kind?