Introduction: Small airway dysfunction (SAD) is associated with type 2 inflammation in patients who have non-asthmatic chronic rhinosinusitis with nasal polyps (CRSwNPs); however, the risk factors for abnormal small airway function indicators in CRSwNP patients with and without asthma remain unclear. Methods: We retrospectively analyzed 41 asthmatic and 109 non-asthmatic CRSwNP patients. Clinical characteristics were compared between groups, correlations between small airway function and clinical parameters were calculated, and independent risk factors for every small airway indicator were identified in each group. Results: Asthmatic CRSwNP patients had significantly reduced small airway function, and the proportion of patients with SAD was higher in asthmatic CRSwNP patients (65.85%) than in patients without asthma (9.17%). With regard to specific airway function indicators, age and a patient’s blood eosinophil (%) were identified as independent risk factors for lower FEF50% %pred and FEF25–75% pred, with age being an independent risk factor for FEF75% %pred in asthmatic CRSwNP patients. In non-asthmatic CRSwNP patients, allergic rhinitis comorbidity was found to be an independent risk factor for FEF50% %pred, FEF75% %pred, and FEF25–75% %pred. Conclusion: Physicians should pay greater attention to risk factors for abnormal small airway function indicators in patients with CRSwNPs to prevent the occurrence of SAD.

1.
Fokkens
WJ
,
Lund
VJ
,
Hopkins
C
,
Hellings
PW
,
Kern
R
,
Reitsma
S
.
European position paper on rhinosinusitis and nasal polyps 2020
.
Rhinology
.
2020
58
Suppl S29
1
464
.
2.
Hellings
PW
,
Steelant
B
.
Epithelial barriers in allergy and asthma
.
J Allergy Clin Immunol
.
2020
;
145
(
6
):
1499
509
.
3.
Kariya
S
,
Okano
M
,
Higaki
T
,
Noyama
Y
,
Haruna
T
,
Ishihara
H
.
Chronic rhinosinusitis patients have decreased lung function
.
Int Forum Allergy Rhinol
.
2014
;
4
(
10
):
828
33
.
4.
Kariya
S
,
Okano
M
,
Oto
T
,
Higaki
T
,
Makihara
S
,
Haruna
T
.
Pulmonary function in patients with chronic rhinosinusitis and allergic rhinitis
.
J Laryngol Otol
.
2014
;
128
(
3
):
255
62
.
5.
Polverino
F
,
Soriano
JB
.
Small airways and early origins of COPD: pathobiological and epidemiological considerations
.
Eur Respir J
.
2020
;
55
(
3
):
1902457
.
6.
Bonini
M
,
Usmani
OS
.
The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease
.
Ther Adv Respir Dis
.
2015
;
9
(
6
):
281
93
.
7.
Burgel
PR
.
The role of small airways in obstructive airway diseases
.
Eur Respir Rev
.
2011
;
20
(
119
):
23
33
.
8.
Postma
DS
,
Brightling
C
,
Baldi
S
,
Van den Berge
M
,
Fabbri
LM
,
Gagnatelli
A
.
Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study
.
Lancet Respir Med
.
2019
;
7
(
5
):
402
16
.
9.
Du
K
,
Zheng
M
,
Zhao
Y
,
Xu
W
,
Hao
Y
,
Wang
Y
.
Impaired small airway function in non-asthmatic chronic rhinosinusitis with nasal polyps
.
Clin Exp Allergy
.
2020
;
50
(
12
):
1362
71
.
10.
Wise
SK
,
Lin
SY
,
Toskala
E
.
International consensus statement on allergy and rhinology: allergic rhinitis-executive summary
.
Int Forum Allergy Rhinol
.
2018
;
8
(
2
):
85
107
.
11.
Global Initiative for Asthma
Global strategy for asthma management and prevention
.
2021
.
12.
Gevaert
P
,
Calus
L
,
Van Zele
T
,
Blomme
K
,
De Ruyck
N
,
Bauters
W
.
Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma
.
J Allergy Clin Immunol
.
2013
;
131
(
1
):
110
6.e1
.
13.
Lund
VJ
,
Kennedy
DW
.
Staging for rhinosinusitis
.
Otolaryngol Head Neck Surg
.
1997
117
S3
S35
40
.
14.
Bonnans
C
,
Chou
J
,
Werb
Z
.
Remodelling the extracellular matrix in development and disease
.
Nat Rev Mol Cell Biol
.
2014
;
15
(
12
):
786
801
.
15.
Moitra
S
,
Simoni
M
,
Baldacci
S
,
Maio
S
,
Angino
A
,
Silvi
P
.
Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: a multicentre European study
.
Clin Transl Allergy
.
2023
;
13
(
2
):
e12209
.
16.
Haccuria
A
,
Van Muylem
A
,
Malinovschi
A
,
Doan
V
,
Michils
A
.
Small airways dysfunction: the link between allergic rhinitis and allergic asthma
.
Eur Respir J
.
2018
;
51
(
2
):
1701749
.
17.
Wang
M
,
Gong
L
,
Luo
Y
,
He
S
,
Zhang
X
,
Xie
X
.
Transcriptomic analysis of asthma and allergic rhinitis reveals CST1 as a biomarker of unified airways
.
Front Immunol
.
2023
;
14
:
1048195
.
18.
Fokkens
WJ
,
Lund
V
,
Bachert
C
,
Mullol
J
,
Bjermer
L
,
Bousquet
J
.
EUFOREA consensus on biologics for CRSwNP with or without asthma
.
Allergy
.
2019
;
74
(
12
):
2312
9
.
19.
Tomassen
P
,
Vandeplas
G
,
Van Zele
T
,
Cardell
LO
,
Arebro
J
,
Olze
H
.
Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers
.
J Allergy Clin Immunol
.
2016
;
137
(
5
):
1449
56.e4
.
20.
Brescia
G
,
Barion
U
,
Zanotti
C
,
Giacomelli
L
,
Martini
A
,
Marioni
G
.
The prognostic role of serum eosinophil and basophil levels in sinonasal polyposis
.
Int Forum Allergy Rhinol
.
2017
;
7
(
3
):
261
7
.
21.
Brescia
G
,
Marioni
G
,
Franchella
S
,
Ramacciotti
G
,
Velardita
C
,
Giacomelli
L
.
Can a panel of clinical, laboratory, and pathological variables pinpoint patients with sinonasal polyposis at higher risk of recurrence after surgery
.
Am J Otolaryngol
.
2015
;
36
(
4
):
554
8
.
22.
Zhao
QL
,
Yu
L
,
Zhi
LL
,
Jin
P
,
Zi
XX
,
Zhao
L
.
The relationship between lung function and the clinical and histopathological features in Chinese patients with nasal polyps
.
J Laryngol Otol
.
2017
;
131
(
10
):
880
8
.
23.
Sutherland
ER
,
Martin
RJ
,
Bowler
RP
,
Zhang
Y
,
Rex
MD
,
Kraft
M
.
Physiologic correlates of distal lung inflammation in asthma
.
J Allergy Clin Immunol
.
2004
;
113
(
6
):
1046
50
.
24.
Williamson
PA
,
Vaidyanathan
S
,
Clearie
K
,
Barnes
M
,
Lipworth
BJ
.
Airway dysfunction in nasal polyposis: a spectrum of asthmatic disease
.
Clin Exp Allergy
.
2011
;
41
(
10
):
1379
85
.
25.
Hogg
JC
,
Paré
PD
,
Hackett
TL
.
The contribution of small airway obstruction to the pathogenesis of chronic obstructive pulmonary disease
.
Physiol Rev
.
2017
;
97
(
2
):
529
52
.
26.
Gibson
PG
,
McDonald
VM
,
Marks
GB
.
Asthma in older adults
.
Lancet
.
2010
;
376
(
9743
):
803
13
.
27.
Adams
RJ
,
Wilson
DH
,
Appleton
S
,
Taylor
A
,
Dal Grande
E
,
Chittleborough
CR
.
Underdiagnosed asthma in South Australia
.
Thorax
.
2003
;
58
(
10
):
846
50
.
28.
Boonpiyathad
T
,
Sözener
ZC
,
Satitsuksanoa
P
,
Akdis
CA
.
Immunologic mechanisms in asthma
.
Semin Immunol
.
2019
;
46
:
101333
.
29.
Du
K
,
Zheng
M
,
Zhao
Y
,
Xu
W
,
Hao
Y
,
Wang
Y
.
Impaired small airway function in non-asthmatic chronic rhinosinusitis with nasal polyps
.
Clin Exp Allergy
.
2020
;
50
(
12
):
1362
71
.
30.
Ciprandi
G
,
Cirillo
I
,
Pistorio
A
.
Impact of allergic rhinitis on asthma: effects on spirometric parameters
.
Allergy
.
2008
;
63
(
3
):
255
60
.
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