Nasal polyp eosinophilia and FeNO may predict asthma symptoms development after endoscopic sinus surgery in CRS patients without asthma

Abstract

Background

Asthma is a significant comorbidity of eosinophilic chronic rhinosinusitis (CRS). Type2-driven biomarkers such as sinus tissue eosinophilia and fractional nitric oxide (FeNO) may be utilized to detect high risk patients who develop asthma symptoms after endoscopic sinus surgery (ESS) in CRS patients.

Methods

Thirty-six CRS patients without asthma who agreed to undergo ESS between October 2015 and December 2017 were prospectively observed for 12 months following ESS. They were monitored for the development of typical asthma symptoms including dyspnea, wheezes, and cough which responded to anti-asthma medication. Biomarkers were compared between patients who developed asthma symptoms after ESS (asthma symptoms group) and those who did not (non-asthma group). Biomarker changes following ESS intervention were also evaluated.

Results

Six patients were lost to follow after ESS. Thus, 30 CRS patients [16 with nasal polyps (NPs) proved by surgery] were followed. Seven (23%) newly complained of asthma symptoms during follow-up. Levels of FeNO and the prevalence of eosinophilic NPs (eosinophils ≥ 70/high power fields) were significantly higher in the asthma symptom group than in non-asthma group [50.7 ppb vs 22.4 ppb for FeNO levels, and 100% (n = 3) vs 23% (n = 3) for eosinophilic NP prevalence, both p < 0.05]. Levels of sputum periostin decreased significantly by ESS in the non-asthma group. However, changes of biomarkers after ESS were comparable between the two groups.

Conclusions

Eosinophils in NPs (≥70/high power fields) and preoperative FeNO may be significant biomarkers for predicting the development of asthma symptoms after ESS.

Keywords:

• Chronic rhinosinusitis
• asthma
• nasal polyps

Acknowledgement

We thank Dr. Rachel Dockry, The University of Manchester, for grammatical support of English.

Authors’ contributions

Y.K.: established the conception of the whole study, and contributed to the performance of diagnostic tests, the collection of data, the recruitment of patients, disease diagnosis and management, the acquisition and interpretation of data, and drafting the manuscript. K.F., R.K., and N.T. contributed to the performance of diagnostic tests, the collection of data, and the acquisition and interpretation of data. S.F., T.U., T.T., H.O., K.M., Y.I., and T.O. contributed to the diagnostic tests, the collection of data, and management of patients. J.O. and K.I. carried out the measurement of periostin. A.M. made specimens and assessed the infiltration of eosinophils in upper airway tissues. Y.O. contributed to assess the radiological severity of CRS. M.T. contributed to the recruitment of patients, disease diagnosis and management, and revision of the manuscript. M.S. and A.N. contributed to the recruitment of patients, disease diagnosis and management, interpretation of data, and revision of the manuscript.

Declaration of interest

Y.K. reports research grants from Novartis Pharma, and Tanabe Mitsubishi pharma for the submitted work, and grants from MSD and Kyowa-Kirin corporations outside the submitted work. K.F. reports research grants from Novartis Pharma, and GSK outside the submitted work. S.F. reports personal fees from AstraZeneca, personal fees from Eli Lilly Japan outside the submitted work. H.O. reports research grant from Boehringer Ingelheim outside the submitted work. K.M. reports personal fees from Pfizer and Chugai Pharmaceutical outside the submitted work. T.O. reports personal fees from AstraZeneca, Eli Lilly Japan, Taiho Pharmaceutical, Pfizer, Chugai Pharmaceutical, MSD, Daiichi Sankyo, and Asahi Kasei Pharma, and research grants and personal fees from Kyowa Hakko Kirin, Boehringer Ingelheim, Ono Pharmaceutical, and Novaltis outside the submitted work. K.I. reports research grants from Shino-Test Corporation for the submitted work. M.T reports research grant from Pfizer outside the submitted work. M.S. reports research grants from Kobayashi Foundation for the submitted work. A.N. reports personal fees from Astellas, AstraZeneca, Kyorin, GSK, MSD, Shionogi, Bayer, Sanofi, Taiho and Boehringer Ingelheim, and research grants from Astellas, Kyorin, Boehringer Ingelheim, Novartis, MSD, Daiichi Sankyo, Taiho, Teijin, Ono, Takeda, Sanofi Pharmaceutical outside the submitted work.

Additional information

Funding

This study was supported in part by research grants from Novartis Pharma, Mitsubishi Tanabe pharma, and Kobayashi Foundation.

Funding

This study was supported in part by research grants from Novartis Pharma, Mitsubishi Tanabe pharma, and Kobayashi Foundation.