phenylephrine-hydrochloride and Asthma

Granulomatous and vasculitic diseases of the airway may be part of more widespread systemic disease but can occur in isolation. They may present to the ear, nose, and throat (ENT) surgeon initially with vague symptoms that mimic more common chronic inflammatory unified airway conditions, such as rhinitis, chronic rhinosinusitis, and asthma. Early diagnosis is associated with better long-term outcomes, so a high index of suspicion is required. Bloody nasal discharge and crusting are highly suspicious for granulomatous disease, which should also be considered in atypical or recalcitrant disease. A combination of clinical findings, serologic tests, imaging, and histology may be required to confirm the diagnosis..

Topics: Asthma; Chronic Disease; Humans; Nose; Pharynx; Rhinitis; Sinusitis

To review the recent literature on the effects of wildfire smoke (WFS) exposure on asthma and allergic disease, and on potential mechanisms of disease.. Spatiotemporal modeling and increased ground-level monitoring data are allowing a more detailed picture of the health effects of WFS exposure to emerge, especially with regard to asthma. There is also epidemiologic and some experimental evidence to suggest that WFS exposure increases allergic predisposition and upper airway or sinonasal disease, though much of the literature in this area is focused more generally on PM

Topics: Air Pollutants; Animals; Asthma; Environmental Exposure; Humans; Nose; Particulate Matter; Smoke; Wildfires

Allergic airway disease is a chronic airway allergic inflammatory disease including allergic rhinitis (AR) and allergic asthma which is common in children and adolescents. Recently the probiotics has been becoming a supplementary or alternative therapy to allergic diseases, however the effect of them has not been clearly established.. The purpose of the present meta-analysis was to evaluate the effectiveness of probiotics on allergic airway disease including AR and allergic asthma in children and adolescents.. We performed a comprehensive search on PubMed, Cochrane Library, EMBASE for relevant publications from 1 Jan 2000 to 1 July 2021. Physical examinations, Pediatric Rhinoconjunctivitis Quality of Life Questionnaires (PRQLQs), Total Nasal Symptom Score (TNSS), Nasal or Eye Symptom Score (NSS or ESS), serum allergen-specific IgE, and eosinophil were used as evaluating indicators for AR and allergic asthma in children and adolescents. The meta-analysis was performed using Review Manager (RevMan, Version 5.3).. 15 randomized controlled trials (RCTs) with a total of 1388 participants were included for the meta-analysis. Among them, 729 patients treated with probiotics served as the probiotics group, and 659 patients with placebo as control group. Significantly greater reduction in PRQLQs from baseline to endpoint (SMD = -2.57, 95% CI [ - 4.66, -0.48] P < 0.01), NSS (SMD = -1.43, 95% CI [ - 1.63, - 1.23], P < 0.01) and ESS (total MD = -1.67, 95% CI [ - 1.79, - 1.55], P < 0.01) were observed in probiotics group compared to control group. Probiotics have no significant effect to serum IgE and eosinophils (P > 0.01).. The results of this meta-analysis indicated that probiotics treatment may reduce PRQLQs, NSS, ESS in patients with allergic airway disease. More research involving the mechanism of probiotics are needed to clarify the role of probiotics in AR and allergic asthma in children and adolescents.

Topics: Adolescent; Asthma; Child; Conjunctivitis; Humans; Immunoglobulin E; Nose; Probiotics; Randomized Controlled Trials as Topic; Rhinitis, Allergic

Evidence supports the relationship between the skin barrier and allergic conditions. This narrative review evaluates what role the cutaneous barrier may play in the pathogenesis, disease course, and management of allergic rhinitis (AR).. A literature review of the MEDLINE (PubMed), Embase, Cochrane, and SCOPUS Sciverse databases was conducted to identify available evidence. Reference lists of pertinent papers were searched using a snowball technique.. Papers published in English from all years until December 2020 were included. Papers that did not address the relationship between AR and the skin and hypothesis papers were excluded.. The cutaneous barrier shares histologic characteristics with the sinonasal epithelial barrier, which may explain commonalities between AR and atopic dermatitis. A disruption in the epithelial barrier could be a common pathway in the development of multiple allergic conditions. The skin is a common target for the treatment of AR. Available data that look at the relationship between the skin and AR often include other topics such as other atopic disorders and the role of the epithelial barrier. Increased understanding of how the cutaneous barrier affects AR may lead to new innovations in its management.. The connection between the cutaneous barrier and AR holds possibilities for further investigation, and these may lead to a better understanding and future innovations for all atopic diseases.

Topics: Asthma; Dermatitis, Atopic; Epithelium; Humans; Nose; Rhinitis, Allergic; Skin; Tight Junctions

Staphylococcus aureus (SA) is a frequent colonizer in humans, and it is known to be associated with chronic allergic diseases including asthma. Recent individual studies suggested that nasal SA colonization may be positively associated with asthma.. To examine relationships between nasal SA colonization and asthma prevalence and activity in adults.. Electronic databases were searched for studies published until June 2018. Studies that reported nasal SA colonization prevalence and asthma outcome (prevalence and disease activity) in general adult populations or patients with chronic rhinosinusitis (CRS) were included. Random effects meta-analyses were performed to calculate pooled odds ratio (OR) of the relationships. Subgroup analysis was conducted for the presence of nasal polyps within CRS populations.. A total of 21 cross-sectional studies were identified, and the data from 16 studies using culture methods for SA detection were meta-analyzed (5 general population-based studies and 11 studies of patients with CRS). In studies of general populations, nasal SA colonization had significant relationships with asthma prevalence (OR 1.19; 95% confidence interval [CI] 1.06-1.34; I. This study demonstrated modest but significant relationships between nasal SA colonization and asthma, supporting potential roles of SA in adult patients with asthma. Further longitudinal cohort and intervention studies are warranted to identify host determinants and to clarify causality of the relationships.

Topics: Adult; Asthma; Chronic Disease; Humans; Nose; Prevalence; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

Chronic cough is one of the most common and troublesome nonspecific respiratory symptom for which patients seek a general practitioner and specialist advice. It is conventionally defined as a cough lasting for more than 8 weeks. Exhaled nitric oxide has proven to be a specific biomarker capable to discriminate between differential diagnoses of chronic cough and simultaneously provide information about the response to specific treatment. In this review, we will discuss the potential use of exhaled and nasal nitric oxide in the diagnosis of chronic chough.

Topics: Asthma; Biomarkers; Breath Tests; Chronic Disease; Cough; Exhalation; Humans; Nitric Oxide; Nose

The united airway concept in which upper and lower respiratory conditions are present in one patient requires special consideration. There is some evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and combined management is still lacking, a fact that leads to discussion. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis. On the other hand, patients with asthma have a greater prevalence of rhinosinusitis than patients without asthma. The effect of chronic rhinosinusitis in patients with or without nasal polyps on asthma treatment, whether medical or surgical, is controversial. Some studies show worsening, other trials improvement, and others no effect. Direct comparisons between surgical and medical treatments are few. Most of the current literature available about this intriguing combination does not provide a good level of evidence. Thus, randomized clinical trials should be performed to better understand the management when asthma and CRS occur together. This review aims to summarize the current state of this association regarding the effects of different types of treatment.

Topics: Asthma; Chronic Disease; Diagnosis, Differential; Humans; Nose; Rhinitis; Treatment Outcome

Immune responses can be compartmentalized into innate versus adaptive components. This relatively recent dichotomy positioned the innate immune system at the interface between the host and the external environment and provided a new conceptual framework with which to view allergic diseases, including asthma. Airway epithelial cells and dendritic cells are key components of the innate immune system in the nose and lung and are now known to be intimately involved in allergen recognition and in modulating allergic immune responses. Here we review current thinking about how these two key cell types sense and respond to inhaled allergens, and emphasize how an understanding of "allergic innate immunity" can translate into new thinking about mechanisms of allergen sensitization and potentially lead to new therapeutic targets.

Topics: Allergens; Asthma; Dendritic Cells; Humans; Immunity, Innate; Immunologic Factors; Inhalation; Lung; Nose; Respiratory Mucosa

Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

Topics: Asthma; Bronchi; Humans; Nose; Pulmonary Disease, Chronic Obstructive; Rhinitis; Sinusitis

The relationship between allergic rhinitis and asthma is now established, and most of the clinical, epidemiological and biological data recommend integrated management. Epithelial cells represent the first barrier of the upper and lower respiratory tracts and thus are logical targets for a comprehensive integrated therapeutic approach. This review discusses rhinosinusitis as a co-morbid condition, a precipitating or triggering condition, and an epiphenomenon as an integrated part of the disease. A better understanding and a more pragmatic method of diagnosis and management is needed using cost-effective long-term strategies.

Topics: Anti-Inflammatory Agents; Asthma; Bronchi; Comorbidity; Epithelial Cells; Humans; Nose; Rhinitis; Sinusitis

During the past few decades, the incidence of sensitization to inhaled allergens as well as allergic airways disease has grown steadily. Genetic and environmental factors are recognized as etiologic factors in the development of allergic airway disease, with allergic rhinitis often preceding the development of asthma. Allergic rhinitis is considered a risk factor for the development of asthma, and almost all allergic asthmatic patients have rhinitis. Insight into the risk factors responsible for allergic airways disease and the interaction between the involved organs results in a better diagnostic and therapeutic approach in global airway allergy syndrome.. Recent studies have shown that local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. In addition, impaired nasal function affects the lower airways of asthmatic patients via different pathways. To date, most human and animal data point towards a systemic pathway linking the upper and lower airways, involving both bloodstream and bone marrow. Recent clinical trials and current guidelines underline the importance of an integrated treatment strategy involving both ends of the respiratory tract.. This review provides an overview of recent epidemiological and immunopathologic evidence concerning the link between upper and lower airways in allergic disease and its therapeutic implications.

Topics: Asthma; Bronchi; Humans; Nose; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastroesophageal reflux disease (GORD), and laryngopharyngeal reflux (LPR) are the commonest causes of chronic cough in the immunocompetent, non-smoking patient who is not taking an angiotensin-converting enzyme inhibitor. No diagnostic test has been found to define those who are said to have PNDS other than a response to a first-generation antihistamine. Examining the available evidence suggests that mechanical stimulation of the pharynx by mucus is not an adequate theory for the production of cough. Inflammatory mediators in the lower airways are raised in PNDS, cough variant asthma and GORD, and the theory that an inflammatory process is affecting 'one airway' is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through an as yet undefined pathway, and eosinophil and mast cell mediation appear a likely mechanism.

Topics: Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchitis, Chronic; Chronic Disease; Cough; Eosinophilia; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Mucus; Nose; Syndrome

The vast majority of patients with asthma have rhinitis, and rhinitis is a major independent risk factor for asthma in cross-sectional and longitudinal studies. The relationships between rhinitis and asthma can be viewed under the concept that the 2 conditions are manifestations of one syndrome, the chronic allergic respiratory syndrome, in 2 parts of the respiratory tract. At the low end of the syndrome's severity spectrum, rhinitis appears to be the sole manifestation, although pathologic abnormalities in the lower airways are already present. At the higher end, rhinitis is worse, and the lower airways disease becomes clinically evident. Once manifested, the 2 conditions track in parallel in terms of severity. This parallel relationship is influenced by many interactions between the nasal and the lower airways: some interactions stem from the fact that the nasal passages play a major homeostatic role by conditioning inhaled air, but perhaps even more important is the bidirectional interaction that results from the systemic inflammation that is produced after local allergic reactions. Successful management of the chronic allergic respiratory syndrome requires an integrated view of the airways and an understanding of their interactions.

Topics: Asthma; Humans; Lung; Models, Biological; Nose; Respiratory System; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Syndrome

The link between upper and lower respiratory tracts has been repeatedly observed in the past 50 years but only carefully investigated during the past decade. Several clinical and experimental observations suggested the hypothesis of the unity of upper and lower airways (allergic rhinobronchitis or united airways disease). The relationships between rhinitis (and sinusitis) and asthma also include non-epidemiological aspects such as viral infections and bronchial hyperreactivity. The hypotheses have been confirmed by means of epidemiological observations, functional and immunological evidence and, indirectly, by observing the effects of drugs used mainly for rhinitis on asthma symptoms. In this article, therefore, we collected and reviewed the most relevant experimental results available to support the hypothesis for united airways disease and the studies conducted on the possible mechanisms of nose-lung interaction.

Topics: Asthma; Humans; Lung; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topics: Adrenal Cortex Hormones; Allergens; Animals; Asthma; Bone Marrow; Hematopoiesis; Humans; Lung; Nose; Rhinitis

The main differences in the anatomies of the upper and lower airways are the vascular characteristics and bony surroundings of the upper airways compared with the smooth muscle component and the loose-lying situation of the lower airways. Both allergic asthma and rhinitis involve a similar process of mucosal inflammation in response to allergen exposure, characterized by inflammatory cell infiltration and local release of mediators. In addition, both the upper and lower airways are under similar influences from local neuronal reflexes, exercise, posture and cyclic variations. Challenge tests have been able to demonstrate the roles of the various influences and components in the inflammatory processes of asthma and allergic rhinitis. A particular difference in the response in asthma compared with rhinitis is the degree of non-specific hyperresponsiveness, which is a characteristic of the late response or response to repeated or prolonged exposure to allergen. Responsiveness of the bronchial mucosa in asthma patients is approximately 50 times that of normal (non-allergic or non-asthmatic) subjects, whereas that of the nasal mucosa in allergic rhinitis is only 2-8 times that of control subjects. The inflammatory process involved in hyperresponsiveness is similar in both conditions, involving increased infiltration of eosinophils and subsequent increased mediator release. The greater degree of hyperresponsiveness seen in asthma appears to be a consequence of the anatomical differences between the upper vs the lower airways. Evidence is presented for the contribution of increased airway wall thickness to the hyperresponsiveness in asthma, together with other possible factors, such as decoupling of responder tissue from surrounding tissue, increased smooth muscle contractility, and smooth muscle hypertrophy.

Topics: Allergens; Asthma; Eosinophils; Exercise; Humans; Lung; Nose; Reflex; Rhinitis; Seasons

The association of rhinitis and asthma in the same patient is frequent and requires an appropriate treatment strategy. Several studies have investigated the effect of antirhinitis treatment on concurrent asthma symptoms and pathophysiology. Most of these studies have been performed in patients with seasonal allergic rhinitis and asthma. Treatment with intranasal corticosteroids during the pollen season decreases asthma symptoms and prevents the increase in non-allergic bronchial hyperresponsiveness in patients with a combination of rhinitis and asthma symptoms. This treatment also inhibits the increase in bronchial hyperresponsiveness in patients with rhinitis symptoms alone. The observation that treatment with intranasal corticosteroids reduces non-allergic bronchial hyperresponsiveness in patients with rhinitis is remarkable and will stimulate thought about the mode of action of these drugs. Intranasal sodium cromoglycate has also been studied and, although effective, has been shown to be less effective than intranasal corticosteroids in controlling the accompanying asthma symptoms in patients with seasonal allergic rhinitis and asthma. Treatment with antihistamines also reduced the symptoms of rhinitis and asthma during the pollen season. However, the optimal therapy for patients with a history of seasonal allergic rhinitis and asthma remains to be established. Few data are available on the effect of treatment for perennial allergic rhinitis on perennial asthma. The rather frequent combination of rhinitis and asthma therefore warrants further study.

Topics: Adrenal Cortex Hormones; Anti-Allergic Agents; Anti-Asthmatic Agents; Asthma; Cromolyn Sodium; Histamine H1 Antagonists; Humans; Lung; Nose; Rhinitis

Perennial rhinitis and asthma are clinical syndromes representing a range of overlapping pathologies; accurate classification should therefore precede any comparison. Although the sinonasal cavities, trachea and bronchi have a common respiratory mucosa, there are also anatomical differences. For example, the nose has a capacitance vessel network and the lower airways possess smooth muscle, both of which are responsive to neurohumoral influences. The prevalence of rhinitis and asthma has increased over the last three decades. Rhinitis occurs in around 75% of allergic asthmatics while 20% of perennial allergic rhinitics develop asthma. Eosinophils, and their associated proteins and cytokines, may play a central role in both perennial rhinitis and asthma with and without atopy. The characteristic pathology of asthma can be summarized as a chronic, desquamating, eosinophilic bronchitis. Non-allergic rhinitis with eosinophilia is recognized, but without consistent evidence of epithelial damage. Eosinophils are also present in rhinosinusitis with polyposis, particularly in patients with aspirin sensitivity, in whom asthma also often occurs. Increased mast cell activation and mediator release is evident in both perennial rhinitis and asthma following allergen challenge. The importance of mast cells in non-atopic asthma and polyposis is also recognized. Adhesion molecules may also be upregulated, with an increased number and activation of TH2 lymphocytes. However, allergen-resultant T-cell activation may be less marked in the nose than in the lung. Autonomic imbalance also plays a role in both conditions via changes in neural tone to effector tissues, release of neuropeptides, and interplay with cellular recruitment. Pharmacological manipulation of rhinitis and asthma also illustrates the pathological similarities and differences.

Topics: Asthma; Autonomic Nervous System; Bronchi; Bronchial Hyperreactivity; Eosinophils; Glucocorticoids; Humans; Inflammation; Lung; Nose; Rhinitis, Allergic, Perennial; Sinusitis; Trachea

In order to study the pathophysiology of allergic airway disease and its response to pharmacotherapy, allergic and non-allergic provocation challenge techniques can be employed. Lower airway challenge has been used widely, but the use of nasal challenge is becoming more widespread as its advantages are realized. New measurement techniques are also being used (e.g. acoustic rhinometry), along with more classical methods such as spirometry, peak airflow rate and symptom scores, to determine the response to challenge. In the lungs, allergen challenge produces a biphasic response, which is less clearly defined in the nose. Topical histamine challenge closely resembles the effects of an allergic reaction and acts by stimulating sensory nerve endings. Methacholine is also often used for nasal challenge (often in addition to histamine), due to its effects on glandular sensitivity. Exercise induces bronchoconstriction in asthmatics and can be imitated by inhalation of cold, dry air. Cold air induces glandular hypersecretion and nasal discharge in normal subjects, which is increased in severity in rhinitic patients. Drug effect investigations using antihistamines have shown that histamine is important in producing the symptom of sneezing, whereas nasal blockage is due to vasodilatation rather than plasma exudation and oedema. Beta 2-agonists reduce allergen-induced symptoms by stabilizing mast cells, whereas cholinoceptor antagonists reduce watery nasal secretion. Increased responsiveness of sensory nerves and nasal glands is a characteristic clinical feature of asthma and rhinitis, which is responsible for the symptomatology. These effects can be reduced by topical corticosteroids.

Topics: Asthma; Bronchi; Bronchial Provocation Tests; Humans; Nasal Provocation Tests; Nose; Rhinitis

Topics: Asthma; Humans; Nose

Topics: Acute Disease; Asthma; Humans; Lung; Nose; Paranasal Sinuses; Reflex; Rhinitis; Sinusitis

Topics: Adult; Asthma; Child; Humans; Nasal Polyps; Nose; Nose Diseases; Otitis Media; Respiratory Hypersensitivity; Rhinitis; Seasons; Sinusitis

Topics: Allergens; Animals; Anti-Allergic Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal, Humanized; Asthma; Basophils; Cats; Double-Blind Method; Histamine; Humans; Hypersensitivity; Nose; Omalizumab; Skin

To explore the effection of the pulmonary function of patients of chronic rhinosinusitis (CRS) with asthma which treated with endoscopic sinus surgery (ESS) based comprehensive treatment.. There were 50 cases of chronic rhinosinusitis with asthma whom met the study criteria. 35 cases enrolled in the tri al group, which treated with endoscopic sinus surgery, and routine perioperative tratment. Another 15 cases as control group which underwent conservative treatment. Both groups underwent the rule treatment of asthma. The main monitoring indexes, which included visual analogue scale (VAS) score, endoscopic Lund-Kennedy score, control of asthma symptoms, the pulmonary function which involved forced expiratory volume in first second (FEV1), forced vital capacity (FVC), the ratio of forced expiratory volume in first second and forced vital capacity (FEV1/FVC) and peak expiratory flow (PEF), were measured in the patients of each groups before surgery, follow-up for 1 year and 3-year.. Our study found that the VAS score of CRS with asthma was significantly negatively correlated with FEV1 and PEF (P < 0.05), endoscopic Lund-Kennedy score was significantly negatively correlated with PEF (P < 0.05); After the trial group underwent ESS based comprehensive treatment, the improvement of VAS score and endoscopic Lund-Kennedy score of postoperative compared with preoperative and the same period in the control group were significantly (P < 0.05). The difference of the postoperative asthma control rate of trial group after 1 year and after 3 years, respectively, compared with the same period control group were statistically significant (P < 0.05). The preoperative FEV1, FVC, FEV1/FVC and PEF of trial group compared with preoperative were significantly (P < 0.05). Even the difference of them compared with the same period control group were significantly (P < 0.05), except the FVC in the follow-up 3 years (P = 0.088).. The CRS may aggravate asthma symptoms and affect negatively the pulmonary function, and poor asthma control or aggravate may exacerbate the CRS in the course of CRS with asthma patient. With ESS based on combined therapy, it can improve the condition of CRS significantly and improve the control of asthma symptoms and pulmonary function else.

Topics: Adolescent; Adult; Asthma; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Pulmonary Ventilation; Rhinitis; Sinusitis; Young Adult

Nose breathing ensures that inspired air is warm, filtered and moist and may therefore benefit patients with asthma. It features in some complementary approaches to treat asthma and is encouraged at night in the Buteyko technique by the use of mouth taping. In this pragmatic study we sought to determine whether taping the mouth at night has any effect on asthma control compared with usual breathing in patients with symptomatic asthma, since if it was effective it would be a simple intervention to implement.. This was a randomised, single-blind, crossover study of participants (n=51) with symptomatic asthma (mean FEV(1) 86% predicted). A 4-week period of usual breathing at night was followed by use of mouth taping with microporous tape, as in the Buteyko technique, or vice versa, with a 2-week run-in period and a minimum 2-week washout period of usual breathing between 'treatments'. Primary outcomes were morning peak expiratory flow and symptom scores (Asthma Control Diary). Outcomes were measured and analysed without knowledge of treatment allocation.. Fifty participants completed the study and reported taping their mouth for a median 26 of 28 nights. Although 36 participants said mouth taping was very or fairly acceptable there were no differences between treatments for morning peak expiratory flow (mean difference -1l/min (95%CI, -9 to 7)) or symptoms scores (mean difference -0.12 (95%CI, -0.30 to 0.06)) nor for any secondary measures.. Taping the mouth at night had no effect on asthma control in patients with symptomatic asthma.

Topics: Adolescent; Adult; Aged; Asthma; Breathing Exercises; Bronchodilator Agents; Cross-Over Studies; Female; Forced Expiratory Volume; Humans; Male; Medical Records; Middle Aged; Mouth Breathing; Nose; Patient Satisfaction; Peak Expiratory Flow Rate; Single-Blind Method; Sleep; Surgical Tape; Treatment Outcome; Young Adult

Aspirin (ASA) and several other nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclo-oxygenase (COX) enzyme both isoforms 1 and 2, and can precipitate asthmatic attacks in aspirin-induced asthmatics. Rofecoxib (R) is a novel and specific COX-2 inhibitor which is caracterized by an highly selective COX-2 inhibition, and can be presumed as non cross-reactive with ASA. Aim of the study was to assess the bronchial and the nasal response to R in AIA.. Nineteen subjects with AIA (21-54 years, 7 m, mean FEV1 85.1% pred. +/- 5.4 sd) performed two oral provocation tests: one with increasing doses of ASA and one other of R at a time interval of 2 weeks, according to a randomized, cross-over design. The bronchial and the nasal responses were measured by serial measures of FEV1, and of nasal resistences by acoustic rhinomanometry, respectively.. Anova for trends was used, and p<0.05 accepted.. Mean ASA PD20 was 68.3 mg +/- 12.4 sd. ASA induced a significant broncho-constriction in all patients with AIA: basal FEV1 dropped from 88.9% pred. +/- 6.2sd to 70.1% pred. +/- 6.9sd after 60 min. (Anova p = 0.001). Despite ASA, R was well tolerated: basal FEV1 remained unchanged during the period of observation following the R 25mg ingestion. ASA also precipitated a significant nasal response with increased nasal resistances (anova p < 0.001) and reduced volumes (anova p < 0.001). The nasal function was unchanged following R 25mg.. Despite ASA, Rofecoxib, largely due to its highly specificity for COX-2, proved a drug particularly safe in treating patients with AIA.

Topics: Adult; Aspirin; Asthma; Bronchoconstriction; Cyclooxygenase 2 Inhibitors; Female; Forced Expiratory Volume; Humans; Lactones; Lung; Male; Middle Aged; Nose; Respiratory Function Tests; Rhinomanometry; Sulfones

Fifty-nine children with well-controlled, mild to moderate persistent asthma were studied for the presence and load of torquetenovirus (TTV) in nasal fluid. Rates of TTV positivity and mean nasal TTV loads were not dissimilar to those observed in the general population and in a group of 30 age- and residence-matched healthy control children without a history of asthmatic disease. However, in the children with asthma, 3 important indices of lung function--forced expiratory flow (FEF) in which 25% and 75% of forced vital capacity (FVC) is expired (FEF(25%-75%)), forced expiratory volume in 1 s/FVC, and FEF(25%-75%)/FVC--showed an inverse correlation with nasal TTV load. Furthermore, signs of reduced airflow were more frequent in the children with asthma who had high nasal TTV loads (> or =6 log(10) DNA copies/mL of nasal fluid) than they were in those who had low nasal TTV loads (<6 log(10) DNA copies/mL of nasal fluid), despite similar therapy regimens. In contrast, the control children showed no associations between nasal TTV load and the spirometric indices. Levels of eosinophil cationic protein in sputum were also greater in the children with asthma who had higher nasal viral burdens than they were in those who had lower nasal viral burdens. These findings are the first report of TTV infection status in children with asthma and suggest that TTV might be a contributing factor in the lung impairment caused by this condition.

Topics: Adolescent; Asthma; Child; DNA Virus Infections; DNA, Viral; Female; Forced Expiratory Flow Rates; Forced Expiratory Volume; Humans; Lung; Male; Nose; Respiratory Function Tests; Spirometry; Torque teno virus; Viral Load; Vital Capacity

Aspirin-induced asthma (AIA) is a clinical syndrome characterized by acute airway reaction to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS). The most recent etiological hypothesises is that an overexpression of the enzyme LTC(4) synthase occurs in AIA, with the consequent production of sulfidopeptide leukotrienes (LTs).. Aim of the present study was to assess the effect of Montelukast, a selective cys-LT receptor antagonist, on nasal function, nasal reactivity to ASA and blood markers of eosinophilic inflammation in mild-to-moderate AIA.. Thirty-six nonsmoker subjects with AIA (17 males, 22-52 years) performed a nasal provocation test (NPT) with lysine-aspirin (L-ASA) in baseline and after a 4-week Montelukast 10 mg or placebo treatment. Nasal function was assessed by the acoustic rhinomanometry, and they also performed a lung function test (forced expiratory volume in 1 s), and a blood sample for the eosinophil count and the eosinophil cationic protein (ECP) plasma measurements. After both treatments, all subjects repeated the NPT, the lung function, and the ECP and the eosinophil blood count.. t-Test was used to compare mean values +/- SD between groups, and P < 0.05 was assumed as the level for statistical significance.. Airway patency was never affected by the NPT with L-ASA. In baseline, NPT with L-ASA precipitated a nasal reaction in all subjects, with a substantial increase in nasal resistance (calculated resistance [REQ]; from 0.89 +/- 0.18 to 2.2 +/- 0.17 cmH(2)O/l/min in group M, P < 0.001; and from 0.91 +/- 0.48 to 2.3 +/- 0.21 cmH(2)O/l/min in group P, P < 0.001); and a significant reduction in total nasal volume in at least one nostril (volume [VOL]; from 11.1 +/- 3.2 to 8.1 +/- 4.1 cm(3) in the group M, P < 0.001, and from 12.3 +/- 4.1 to 7.9 +/- 4.5 cm(3) in the group P, P < 0.001). The nasal reaction to L-ASA remained unchanged following placebo, but it was completely minimized following a 4-week treatment with Montelukast. Also nasal function, the nasal symptom score, and the markers of eosinophilic inflammation proved significantly affected and improved by the active drug only.. Montelukast 10 mg daily for 4 weeks, but not placebo, improves nasal function and nasal response to Aspirin substantially in ASA-sensitive asthmatics.

Topics: Acetates; Adult; Airway Resistance; Aspirin; Asthma; Cyclopropanes; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Provocation Tests; Nose; Quinolines; Sulfides

The levels of exhaled and nasal nitric oxide (eNO and nNO) in groups of patients with inflammatory lung diseases are well documented but the diagnostic use of these measurements in an individual is unknown.. The levels of nNO and eNO were compared in 31 children with primary ciliary dyskinesia (PCD), 21 with non-CF bronchiectasis (Bx), 17 with cystic fibrosis (CF), 35 with asthma (A), and 53 healthy controls (C) using a chemiluminescence NO analyser. A diagnostic receiver-operator characteristic (ROC) curve for PCD using NO was constructed.. The median (range) levels of nNO in parts per billion (ppb) in PCD, Bx, CF, and C were 60.3 (3.3-920), 533.6 (80-2053), 491.3 (31-1140), and 716 (398-1437), respectively; nNO levels were significantly lower in PCD than in all other groups (p<0.05). The median (range) levels of eNO in ppb in PCD, Bx, CF, A, and C were 2.0 (0.2-5.2), 5.4 (1.0-22.1), 2.6 (0.8-12.9), 10.7 (1.6-46.7), and 4.85 (2.5-18.3), respectively. The difference in eNO levels in PCD reached significance (p<0.05) when compared with those in Bx, A and C but not when compared with CF. Using the ROC curve, nNO of 250 ppb showed a sensitivity of 97% and a specificity of 90% for the diagnosis of PCD.. eNO and nNO cannot be used diagnostically to distinguish between most respiratory diseases. However, nNO in particular is a quick and useful diagnostic marker which may be used to screen patients with a clinical suspicion of PCD.

Topics: Adolescent; Asthma; Biomarkers; Breath Tests; Bronchiectasis; Child; Cystic Fibrosis; Forced Expiratory Volume; Humans; Kartagener Syndrome; Nitric Oxide; Nose; ROC Curve

Nitric oxide (NO) is produced in large amounts in the noses of normal individuals. We have measured NO by chemiluminescence in the noses and exhaled air of subjects with symptomatic allergic rhinitis, some of whom had concomitant asthma, during the pollen season and compared this with values measured in normal subjects and in patients treated with nasal and/or inhaled glucocorticoids. We found that nasal levels of NO were significantly (p < 0.001) elevated in patients with untreated rhinitis (1527 +/- 87 ppb, n = 12) compared with normal individuals (996 +/- 39 ppb, n = 46) or subjects treated with nasal steroids (681 +/- 34 ppb, n = 10), whereas exhaled NO in patients with untreated rhinitis was similar to that in normal subjects (10 +/- 2 ppb vs 7 +/- 0.6 ppb, respectively). In five subjects who were nasally challenged with allergen, there was a significant decrease in nasal NO 1 hour after challenge, and this was significantly correlated with increased rhinitis symptoms. In patients with rhinitis and concomitant asthma, nasal NO was also significantly elevated (1441 +/- 76 ppb, n = 16) but not when they were treated with nasal or inhaled steroids; whereas exhaled NO was elevated in untreated patients and in patients treated with nasal, but not inhaled, steroids. Our data suggest that the increase in exhaled NO in patients with allergic rhinitis is likely to be due to increased local production, caused by long-term exposure to allergen, which is suppressed by locally administered steroids. Measurement of nasal NO may be useful to study the inflammatory response in rhinitis and its response to antiinflammatory treatments.

Topics: Administration, Inhalation; Administration, Topical; Adult; Allergens; Anti-Inflammatory Agents; Asthma; Female; Glucocorticoids; Humans; Male; Middle Aged; Nasal Mucosa; Nitric Oxide; Nitric Oxide Synthase; Nose; Pollen; Rhinitis, Allergic, Seasonal

The aim of this study was to assess the effects of short-term exposure to low levels of nitrogen dioxide (NO2) on airway inflammation. We studied seven normal, eight mild asthmatic and seven chronic obstructive pulmonary disease (COPD) subjects. All subjects were exposed to air or to 0.3 parts per million (ppm) NO2 for 1 h, with moderate intermittent exercise, on different days and in random order. Before and 2 h after exposure, symptom score and results of pulmonary function tests (PFTs) were assessed. All subjects performed nasal lavage and hypertonic saline (HS) inhalation to collect sputum 2 h after both exposures. Asthmatic subjects had a higher percentage of eosinophils than normal and COPD subjects in HS-induced sputum after air (asthmatics: median 13 (range 0.4-37)%; normals: 0 (range 0-2)%; COPD 1.8 (range 0.1-19)%), whilst COPD patients showed a higher percentage of neutrophils than the two others groups. No significant differences in PFT values or percentages of inflammatory cells were observed in nasal lavage and in HS-induced sputum in normal, asthmatic and COPD subjects after NO2 exposure compared to air exposure, except for a mild decrease in forced expiratory volume in one second (FEV1) 2 h after NO2 exposure in COPD patients. Symptom score showed a mild increase after NO2 exposure both in normal subjects and in COPD patients. We conclude that short-term exposure to 0.3 ppm nitrogen dioxide does not induce an early detectable acute inflammation in proximal airways of normal subjects or of patients with asthma or chronic obstructive pulmonary disease.

Topics: Administration, Inhalation; Adult; Asthma; Bronchitis; Bronchoalveolar Lavage; Environmental Exposure; Eosinophils; Female; Forced Expiratory Volume; Humans; Leukocyte Count; Lung; Lung Diseases, Obstructive; Male; Middle Aged; Neutrophils; Nitrogen Dioxide; Nose; Oxidants, Photochemical; Physical Exertion; Saline Solution, Hypertonic; Single-Blind Method; Sputum; Time Factors; Vital Capacity

Aspirin (ASA) and other non-steroidal anti-inflammatory drugs, which are cyclooxygenase (COX) inhibitors, precipitate asthmatic attacks in ASA-intolerant patients, while sodium salicylate, hardly active on COX by itself, is well tolerated by these patients. However, salicylate moiety appears to interfere with aspirin inhibitory action on platelets and vascular COX. Such interaction, if present at the level of respiratory tract, may be of interest to pathogenesis of ASA-induced asthma. We performed a double-blind, placebo-controlled, randomized cross-over study on the effect of choline magnesium trisalicylate (CMT, trilisate) pre-treatment on ASA-induced adverse reactions in nine patients. Pulmonary function tests, nasal symptoms score, PNIF and serum salicylate levels were monitored following challenges with threshold doses of ASA. Trilisate administered at a dose of 3000 mg daily for 3 days, offered a moderate protection against ASA-induced symptoms; it diminished the severity and/or delayed the appearance of FEV1 fall. Maximal decreases in FEV1 as well as reaction intensity indexes were significantly lower (P less than 0.02 and P less than 0.002, respectively) after trilisate pre-treatment as compared to placebo. Trilisate also attenuated nasal symptoms in three out of five patients. Although the precise mechanism of the protective action of trilisate is unknown, our data support the possibility of interaction between salicylate and ASA on cyclo-oxygenase locus in the respiratory tract in ASA-intolerant patients.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Bronchial Spasm; Choline; Double-Blind Method; Drug Hypersensitivity; Drug Tolerance; Female; Humans; Male; Middle Aged; Nose; Salicylates

Ten adolescent subjects with extrinsic asthma were exposed during intermittent exercise to filtered air, 0.5 ppm of sulfur dioxide (SO2), or 100 micrograms/m3 of sulfuric acid (H2SO4) on 5 separate days. The purpose of the study was to compare changes in nasal power (the work of nose breathing) with pulmonary functional changes depending on the route of inhalation of the sulfur oxide pollutants, oral inhalation through a rubber mouthpiece or oronasal inhalation via a face mask. Nasal power was measured with a modified skin diving mask equipped with two differential pressure transducers. Statistically significant changes in total respiratory resistance, FEV1, and maximum flow calculated at 50% and 75% vital capacity were observed after all exposures to SO2 and H2SO4. The magnitude of change in FEV1 and maximum flow calculated at 50% vital capacity was higher after oral compared to oronasal inhalation of SO2. The nasal work of breathing increased 32% after SO2 exposure by mouthpiece and 30% after SO2 exposure via face mask (p less than 0.05). The nasal power changes after the H2SO4 exposures were not different from the sham exposures. We conclude that oronasal inhalation of 0.5 ppm of SO2 produces a significant increase in the nasal work of breathing and that the route of exposure reduces but does not eliminate the lower airway reactions observed on oral exposure.

Topics: Adolescent; Asthma; Female; Forced Expiratory Volume; Humans; Lung; Male; Nose; Sulfur Oxides

The effect of intranasally administered corticosteroid (budesonide) on nasal symptoms, mode of respiration (nasal versus mouth breathing), and asthma was investigated in 37 asthmatic children who were mouth breathers because of chronic nasal obstruction. After a 2-wk run-in period, the children were allocated randomly to 4 wk of intranasal therapy with either budesonide (400 micrograms/day) or placebo spray. A double-blind, parallel design was used. Diaries for peak expiratory flow, asthma, and rhinitis symptom scores and degree of mouth breathing were recorded at home. Nasal eosinophilia, nasal airway resistance at a flow of 0.2 L/s (NAR0.2), and lung function at rest and after exercise challenge were assessed at the clinic immediately before and at end of the 4-wk treatment. Budesonide, when compared with placebo, significantly decreased nasal obstruction (p less than 0.05), secretion (p less than 0.01), and eosinophilia (p less than 0.02), as well as NAR0.2 (p less than 0.05) and mouth breathing (p less than 0.01). The improvement in nasal obstruction correlated closely to the changes in mouth breathing (r = 0.80, n = 17, p less than 0.001). Furthermore, intranasally administered budesonide resulted in less exercise-induced asthma (EIA) (p less than 0.02) and decreased cough and asthma severity significantly. Pulmonary mechanics were only marginally improved. The present study showed that intranasally administered budesonide is effective in the treatment of perennial allergic rhinitis. An attenuation of EIA and a tendency to less asthma after budesonide therapy suggest a decrease in bronchial reactivity, but the results gave no clear evidence of an association between nasal airway function and asthma.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Double-Blind Method; Eosinophilia; Female; Humans; Male; Mouth Breathing; Nose; Nose Diseases; Peak Expiratory Flow Rate; Pregnenediones; Respiratory Function Tests

The influence of mouth breathing on craniofacial development has previously been demonstrated. Recent investigations do indicate, however, that head posture also might be related to craniofacial morphology. The aim of the present study was to analyze the effect of a topical steroid spray (Budesonide) on nasal respiratory resistance and head posture in children with asthma and nasal obstruction. Thirty-seven children, 8 to 15 years of age, with bronchial asthma, perennial allergic rhinitis, and subjectively assessed mouth breathing were selected for the study. Rhinomanometric and cephalometric analyses were performed. Head posture was defined as the position of the head relative to the cervical column and to the true vertical. After the first examination the children were randomly allocated to two groups, of which one group was treated intranasally with Budesonide (N = 18) and the other with placebo (N = 19), for a double-blind study. After one month of treatment, there was a statistically significant decrease in nasal resistance (p less than 0.001) and an increased flexing of the head (p less than 0.01) (paired t tests) in the children under active treatment. No significant changes were seen in the placebo group. The results indicate that Budesonide nasal spray is capable of reducing nasal obstruction in allergic children and that a reduced nasal resistance leads to a decrease in craniocervical angulation. The clinical importance of these results is yet to be clarified.

Topics: Adolescent; Airway Resistance; Asthma; Budesonide; Cephalometry; Child; Double-Blind Method; Female; Head; Humans; Male; Nose; Pregnenediones; Rhinitis, Allergic, Perennial

Topics: Adolescent; Adult; Allergens; Animals; Asthma; Bronchi; Desensitization, Immunologic; Dogs; Epithelium; Female; Humans; Hypersensitivity; Immunoglobulin E; In Vitro Techniques; Male; Middle Aged; Nose; Pollen; Rhinitis, Allergic, Seasonal; Skin Tests

Topics: Adolescent; Adult; Asthma; Child; Clinical Trials as Topic; Desensitization, Immunologic; Eczema; Female; Histamine Release; Humans; Immunoglobulin E; Immunoglobulin G; Leukocytes; Lymphocyte Activation; Male; Mites; Nose; Placebos; Pollen; Rhinitis, Allergic, Seasonal; Skin Tests; Sodium Chloride; Surveys and Questionnaires

Topics: Adolescent; Asthma; Child; Clinical Trials as Topic; Electrodiagnosis; Female; Histamine H1 Antagonists; Humans; Male; Nasal Decongestants; Nose; Placebos; Respiration; Respiratory Hypersensitivity; Rhinitis, Allergic, Seasonal

Characteristics of airway microbiota might influence asthma status or asthma phenotype. Identifying the airway microbiome can help to investigate its role in the development of asthma phenotypes or small airway function.. Bacterial microbiota profiles were analyzed in induced sputum from 31 asthma patients and 12 healthy individuals from Beijing, China. Associations between small airway function and airway microbiomes were examined.. Composition of sputum microbiota significantly changed with small airway function in asthma patients. Two microbiome-driven clusters were identified and characterized by small airway function and taxa that had linear relationship with small airway functions were identified.. Our findings confirm that airway microbiota was associated with small airway function in asthma patients.

Topics: Asthma; Humans; Microbiota; Nose; Sputum; Trachea

Predicting which preschool children with recurrent wheezing (RW) will develop school-age asthma (SA) is difficult, highlighting the critical need to clarify the pathogenesis of RW and the mechanistic relationship between RW and SA. Despite shared environmental exposures and genetic determinants, RW and SA are usually studied in isolation. Based on network analysis of nasal and tracheal transcriptomes, we aimed to identify convergent transcriptomic mechanisms in RW and SA.. RNA-sequencing data from nasal and tracheal brushing samples were acquired from the Gene Expression Omnibus. Combined with single-cell transcriptome data, cell deconvolution was used to infer the composition of 18 cellular components within the airway. Consensus weighted gene co-expression network analysis was performed to identify consensus modules closely related to both RW and SA. Shared pathways underlying consensus modules between RW and SA were explored by enrichment analysis. Hub genes between RW and SA were identified using machine learning strategies and validated using external datasets and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Finally, the potential value of hub genes in defining RW subsets was determined using nasal and tracheal transcriptome data.. Co-expression network analysis revealed similarities in the transcriptional networks of RW and SA in the upper and lower airways. Cell deconvolution analysis revealed an increase in mast cell fraction but decrease in club cell fraction in both RW and SA airways compared to controls. Consensus network analysis identified two consensus modules highly associated with both RW and SA. Enrichment analysis of the two consensus modules indicated that fatty acid metabolism-related pathways were shared key signals between RW and SA. Furthermore, machine learning strategies identified five hub genes, i.e., CST1, CST2, CST4, POSTN, and NRTK2, with the up-regulated hub genes in RW and SA validated using three independent external datasets and qRT-PCR. The gene signatures of the five hub genes could potentially be used to determine type 2 (T2)-high and T2-low subsets in preschoolers with RW.. These findings improve our understanding of the molecular pathogenesis of RW and provide a rationale for future exploration of the mechanistic relationship between RW and SA.

Topics: Asthma; Child, Preschool; Humans; Nose; Respiratory Sounds; Trachea; Transcriptome

Frequent asthma exacerbators, defined as those experiencing more than 1 hospitalization in a year for an asthma exacerbation, represent an important subgroup of individuals with asthma. However, this group remains poorly defined and understudied in children.. Our aim was to determine the molecular mechanisms underlying asthma pathogenesis and exacerbation frequency.. We performed RNA sequencing of upper airway cells from both frequent and nonfrequent exacerbators enrolled in the Ohio Pediatric Asthma Repository.. Through molecular network analysis, we found that nonfrequent exacerbators display an increase in modules enriched for immune system processes, including type 2 inflammation and response to infection. In contrast, frequent exacerbators showed expression of modules enriched for nervous system processes, such as synaptic formation and axonal outgrowth.. These data suggest that the upper airway of frequent exacerbators undergoes peripheral nervous system remodeling, representing a novel mechanism underlying pediatric asthma exacerbation.

Topics: Asthma; Child; Disease Progression; Humans; Inflammation; Nose; Pulmonary Disease, Chronic Obstructive; Transcriptome

Asthma is a heterogeneous respiratory disease characterized by airway inflammation and obstruction. Despite recent advances, the genetic regulation of asthma pathogenesis is still largely unknown. Gene expression profiling techniques are well suited to study complex diseases including asthma. In this study, differentially expressed genes (DEGs) followed by weighted gene co-expression network analysis (WGCNA) and machine learning techniques using dataset generated from airway epithelial cells (AECs) and nasal epithelial cells (NECs) were used to identify candidate genes and pathways and to develop asthma classification and predictive models. The models were validated using bronchial epithelial cells (BECs), airway smooth muscle (ASM) and whole blood (WB) datasets. DEG and WGCNA followed by least absolute shrinkage and selection operator (LASSO) method identified 30 and 34 gene signatures and these gene signatures with support vector machine (SVM) discriminated asthmatic subjects from controls in AECs (Area under the curve: AUC = 1) and NECs (AUC = 1), respectively. We further validated AECs derived gene-signature in BECs (AUC = 0.72), ASM (AUC = 0.74) and WB (AUC = 0.66). Similarly, NECs derived gene-signature were validated in BECs (AUC = 0.75), ASM (AUC = 0.82) and WB (AUC = 0.69). Both AECs and NECs based gene-signatures showed a strong diagnostic performance with high sensitivity and specificity. Functional annotation of gene-signatures from AECs and NECs were enriched in pathways associated with IL-13, PI3K/AKT and apoptosis signaling. Several asthma related genes were prioritized including SERPINB2 and CTSC genes, which showed functional relevance in multiple tissue/cell types and related to asthma pathogenesis. Taken together, epithelium gene signature-based model could serve as robust surrogate model for hard-to-get tissues including BECs to improve the molecular etiology of asthma.

Topics: Asthma; Gene Regulatory Networks; Humans; Machine Learning; Nose; Phosphatidylinositol 3-Kinases

New evidence strongly discloses the pathogenesis of host-associated microbiomes in respiratory diseases. The microbiome dysbiosis modulates the lung's behavior and deteriorates the respiratory system's effective functioning. Several exogenous and environmental factors influence the development of asthma and chronic lung disease. The relationship between asthma and microbes is reasonably understood and yet to be investigated for more substantiation. The comorbidities such as SARS-CoV-2 further exacerbate the health condition of the asthma-affected individuals. This study examines the raw 16S rRNA sequencing data collected from the saliva and nasopharyngeal regions of pre-existing asthma (23) and non-asthma patients (82) infected by SARS-CoV-2 acquired from the public database. The experiment is designed in a two-fold pattern, analyzing the associativity between the samples collected from the saliva and nasopharyngeal regions. Later, investigates the microbial pathogenesis, its role in exacerbations of respiratory disease, and deciphering the diagnostic biomarkers of the target condition. LEfSE analysis identified that Actinobacteriota and Pseudomonadota are enriched in the SARS-CoV-2-non-asthma group and SARS-CoV-2 asthma group of the salivary microbiome, respectively. Random forest algorithm is trained with amplicon sequence variants (ASVs) attained better classification accuracy, ROC scores on nasal (84% and 87%) and saliva datasets (93% and 97.5%). Rothia mucilaginosa is less abundant, and Corynebacterium tuberculostearicum showed higher abundance in the SARS-CoV-2 asthma group. The increase in Streptococcus at the genus level in the SARS-CoV-2-asthma group is evidence of discriminating the subgroups.

Topics: Asthma; COVID-19; Humans; Lung; Microbiota; Nose; RNA, Ribosomal, 16S; SARS-CoV-2

Topics: Asthma; Child; Humans; Microbiota; Nose; Seasons; Trachea

Genetic predisposition increases risk for asthma, and distinct nasal microbial compositions are associated with asthma. Host genetics might shape nasal microbiome composition.. We examined associations between host genetics and nasal microbiome composition.. Nasal samples were collected from 584 participants from the Mount Sinai Health System, New York. Seventy-seven follow-up samples were collected from a subset of 40 participants. 16S rRNA sequencing and RNA sequencing were performed on nasal samples. Beta diversity was calculated, variant calling on RNA sequencing data was performed, and genetic relatedness between individuals was determined. Using linear regression models, we tested for associations between genetic relatedness and nasal microbiome composition.. The median age of the cohort was 14.6 (interquartile range 11.2-19.5) years, with participants representing diverse ancestries and 52.7% of the cohort being female. For participants who provided follow-up samples, the median time between samples was 5.1 (interquartile range 1.4-7.2) months. Nasal microbiome composition similarity as reflected by beta diversity was significantly higher within subjects over time versus between subjects (coefficient = 0.091, P = 2.84. Host genetics has little influence on nasal microbiome composition.

Topics: Adolescent; Adult; Asthma; Child; Cohort Studies; Female; Humans; Male; Microbiota; Nose; RNA, Ribosomal, 16S; Young Adult

Childhood allergic diseases, including asthma, rhinitis and eczema, are prevalent conditions that share strong genetic and environmental components. Diagnosis relies on clinical history and measurements of allergen-specific IgE. We hypothesize that a multi-omics model could accurately diagnose childhood allergic disease. We show that nasal DNA methylation has the strongest predictive power to diagnose childhood allergy, surpassing blood DNA methylation, genetic risk scores, and environmental factors. DNA methylation at only three nasal CpG sites classifies allergic disease in Dutch children aged 16 years well, with an area under the curve (AUC) of 0.86. This is replicated in Puerto Rican children aged 9-20 years (AUC 0.82). DNA methylation at these CpGs additionally detects allergic multimorbidity and symptomatic IgE sensitization. Using nasal single-cell RNA-sequencing data, these three CpGs associate with influx of T cells and macrophages that contribute to allergic inflammation. Our study suggests the potential of methylation-based allergy diagnosis.

Topics: Asthma; Child; DNA Methylation; Humans; Hypersensitivity; Immunoglobulin E; Nose

This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in allergic rhinitis (AR) and patients with or without bronchial asthma (BA).A total of 90 patients who were diagnosed with persistent AR (AR group, n = 30), BA (BA group, n = 30), or allergic rhinitis with bronchial asthma (AR-BA) (AR-BA group, n = 30), were enrolled in this study, along with 30 healthy adult volunteers (control group, n = 30). The participants were further divided into 2 groups based on the results of a skin-prick test (SPT): a highly atopic group (SPT = 3+ and above) and a moderately atopic group (SPT = 2+ and below). All participants underwent FeNO and nNO measurement, an absolute blood eosinophil count, total serum immunoglobulin measurement, and horizontal baseline lung capacity determination.The results showed that the FeNO levels in the 3 observation groups were significantly higher than those in the control group (P < .01), and in the BA group they were significantly higher than in the AR-BA group (P < .01). The levels of nNO in both the AR group and the AR-BA group were higher than those in the control group and the BA group (P < .01), but there was no significant difference between the AR group and the AR-BA group (P > .05). The levels of nNO in the BA group were also significantly different from those in the control group (P < .01).FeNO and nNO are positively correlated with the degree of AR in patients with BA; therefore, nNO levels can be used as an inflammatory marker of AR in patients with BA. FeNO can also be used as an inflammatory marker of AR in patients complicated with BA as a warning indicator of asthma.

Topics: Adolescent; Adult; Aged; Asthma; Eosinophils; Exhalation; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nitric Oxide; Nose; Respiratory Function Tests; Rhinitis, Allergic; Young Adult

Topics: Anti-Bacterial Agents; Asthma; Cohort Studies; Humans; Infant; Microbiota; Nose

Nasal transcriptomics can provide an accessible window into asthma pathobiology.. Our goal was to move beyond gene signatures of asthma to identify master regulator genes that causally regulate genes associated with asthma phenotypes.. We recruited 156 children with severe persistent asthma and controls for nasal transcriptome profiling and applied network-based and probabilistic causal methods to identify severe asthma genes and their master regulators. We then took the same approach in an independent cohort of 190 adults with mild/moderate asthma and controls to identify mild/moderate asthma genes and their master regulators. Comparative analysis of the master regulator genes followed by validation testing in independent children with severe asthma (n = 21) and mild/moderate asthma (n = 154) was then performed.. Nasal gene signatures for severe persistent asthma and for mild/moderate persistent asthma were identified; both were found to be enriched in coexpression network modules for ciliary function and inflammatory response. By applying probabilistic causal methods to these gene signatures and validation testing in independent cohorts, we identified (1) a master regulator gene common to asthma across severity and ages (FOXJ1); (2) master regulator genes of severe persistent asthma in children (LRRC23, TMEM231, CAPS, PTPRC, and FYB); and (3) master regulator genes of mild/moderate persistent asthma in children and adults (C1orf38 and FMNL1). The identified master regulators were statistically inferred to causally regulate the expression of downstream genes that modulate ciliary function and inflammatory response to influence asthma.. The identified master regulator genes of asthma provide a novel path forward to further uncovering asthma mechanisms and therapy.

Topics: Adolescent; Asthma; Child; Cohort Studies; Female; Forkhead Transcription Factors; Formins; Gene Expression Profiling; Humans; Intracellular Signaling Peptides and Proteins; Male; Models, Statistical; Nose; Phenotype; Transcriptome

To verify the association between orofacial myofunctional changes and nasal patency.. Observational study of 43 children and adolescents with asthma and/or rhinitis, aged between 5 and 14 years, from May 2017 to September 2019. Patients underwent peak nasal inspiratory flow (PNIF) for nasal patency assessment and orofacial myofunctional assessment. Clinical data were obtained from an interview on the day of the patients' medical evaluation. The relationship between orofacial myofunctional changes and PNIF was analyzed using a logistic regression model. Estimates were reported as odds ratio (OR) and 95% confidence interval (95%CI). We evaluated multicollinearity using the variance inflation factor and analyzed the adjusted fit with the Akaike information criterion and McFadden's R. Inadequate positioning of the mandible (OR = 11.22; 95%CI 1.83-69; p = 0.009) and the presence of tension in the facial muscles during the swallowing of liquid (OR = 4.61; 95%CI 1.31-16.20; p = 0.017) were associated with altered PNIF in children and adolescents with asthma and rhinitis.. Children and adolescents with asthma and rhinitis along with reduced nasal patency presented orofacial myofunctional changes, such as inadequate positioning of the jaw and the presence of tension in the facial muscles during swallowing of liquid.

Topics: Adolescent; Asthma; Child; Child, Preschool; Facial Muscles; Humans; Logistic Models; Nose; Rhinitis

Pet allergies are common in children with asthma. Microbiota and host responses may mediate allergen sensitization.. We sought to uncover host-microbe relationships in pet allergen sensitization via joint examination of the nasal microbiome and nasal transcriptome.. We collected nasal samples from 132 children with asthma for parallel 16S rRNA and RNA sequencing. Specific IgE levels for cat and dog dander were measured. Analyses of the nasal microbiome, nasal transcriptome, and their correlations were performed with respect to pet sensitization status.. Among the 132 children, 91 (68.9%) were cat sensitized and 96 (72.7%) were dog sensitized. Cat sensitization was associated with lower nasal microbial diversity by Shannon index (P = .021) and differential nasal bacterial composition by weighted UniFrac distance (permutational multivariate ANOVA P = .035). Corynebacterium sp and Staphylococcus epidermidis were significantly less abundant, and the metabolic process "fatty acid elongation in mitochondria" was lower in pet-sensitized versus unsensitized children. Correlation networks revealed that the nasal expression levels of 47 genes representing inflammatory processes were negatively correlated with the relative abundances of Corynebacterium sp and S epidermidis. Thus, these species were directly associated not only with the absence of pet sensitization but also with the underexpression of host gene expression of inflammatory processes that contribute to allergen sensitization. Causal mediation analyses revealed that the associations between these nasal species and pet sensitization were mediated by nasal gene expression.. Higher abundances of nasal Corynebacterium sp and S epidermidis are associated with absence of pet sensitization and correlate with lower expression of inflammatory genes.

Topics: Allergens; Animals; Asthma; Cats; Child; Dogs; Female; Humans; Hypersensitivity; Immunoglobulin E; Male; Microbiota; Nose; Pets; RNA, Ribosomal, 16S; Transcriptome

Topics: Air Conditioning; Altitude; Asthma; Humans; Nose; Rhinitis

Topics: Asthma; Betacoronavirus; Coronavirus Infections; COVID-19; Humans; Hypersensitivity; Nose; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; SARS-CoV-2

Although the airway microbiota is a highly dynamic ecology, the role of longitudinal changes in airway microbiota during early childhood in asthma development is unclear. We aimed to investigate the association of longitudinal changes in early nasal microbiota with the risk of developing asthma.. In this prospective, population-based birth cohort study, we followed children from birth to age 7 years. The nasal microbiota was tested by using 16S ribosomal RNA gene sequencing at ages 2, 13, and 24 months. We applied an unsupervised machine learning approach to identify longitudinal nasal microbiota profiles during age 2 to 13 months (the primary exposure) and during age 2 to 24 months (the secondary exposure) and examined the association of these profiles with the risk of physician-diagnosed asthma at age 7 years.. Of the analytic cohort of 704 children, 57 (8%) later developed asthma. We identified 4 distinct longitudinal nasal microbiota profiles during age 2 to 13 months. In the multivariable analysis, compared with the persistent. Children with an altered longitudinal pattern in the nasal microbiota during early childhood had a high risk of developing asthma. Our data guide the development of primary prevention strategies (eg, early identification of children at high risk and modification of microbiota) for childhood asthma. These observations present a new avenue for risk modification for asthma (eg, microbiota modification).

Topics: Aerococcaceae; Age Factors; Asthma; Child; Child, Preschool; Female; Finland; Follow-Up Studies; Gene Expression Profiling; Haemophilus; Humans; Incidence; Infant; Infant, Newborn; Machine Learning; Male; Microbiota; Moraxella; Multivariate Analysis; Nose; Prospective Studies; Respiratory Tract Infections; Risk; RNA, Ribosomal, 16S; Streptococcus

Accurate detection of human respiratory viral infections is highly topical. We investigated how strongly inflammatory biomarkers (FeNO, eosinophils, neutrophils, and cytokines in nasal lavage fluid) and lung function parameters change upon rhinovirus 16 infection, in order to explore their potential use for infection detection. To this end, within a longitudinal cohort study, healthy and mildly asthmatic volunteers were experimentally inoculated with rhinovirus 16, and time series of these parameters/biomarkers were systematically recorded and compared between the pre- and post-infection phases of the study, which lasted two months and one month, respectively. We found that the parameters'/biomarkers' ability to discriminate between the infected and the uninfected state varied over the observation time period. Consistently over time, the concentration of cytokines, in nasal lavage fluid, showed moderate to very good discrimination performance, thereby qualifying for disease progression monitoring, whereas lung function and FeNO, while quickly and non-invasively measurable using cheap portable devices (e.g., at airports), performed poorly.

Topics: Adult; Asthma; Biomarkers; Cytokines; Female; Humans; Inflammation; Longitudinal Studies; Male; Nose; Picornaviridae Infections; Prospective Studies; Respiratory Function Tests; Respiratory Tract Infections; Rhinovirus; Young Adult

Rhinovirus C is an important pathogen of asthmatic and non-asthmatic children hospitalised with episodic wheeze. Previous studies on other respiratory viruses have shown that several host cytokines correlate with duration of hospitalisation, but this has yet to be investigated in children with RV-C infection. We determined the nasal cytokine profiles of these children and investigated their relationship with RV-C load and clinical outcome. Flocked nasal swabs were collected from children aged 24-72 months presenting to the Emergency Department at Princess Margaret Hospital with a clinical diagnosis of acute wheeze and an acute upper respiratory tract viral infection. RV-C load was determined by quantitative RT-PCR and cytokine profiles were characterised by a commercial human cytokine 34-plex panel. RV-C was the most commonly detected virus in pre-school-aged children hospitalised with an episodic wheeze. RV-C load did not significantly differ between asthmatic and non-asthmatic patients. Both groups showed a Th2-based cytokine profile. However, Th17 response cytokines IL-17 and IL-1β were only elevated in RV-C-infected children with pre-existing asthma. Neither RV-C load nor any specific cytokines were associated illness severity in this study. Medically attended RV-C-induced wheeze is characterised by a Th2 inflammatory pattern, independent of viral load. Any therapeutic interventions should be aimed at modulating the host response following infection.

Topics: Asthma; Child; Child, Preschool; Cytokines; Enterovirus; Enterovirus Infections; Female; Humans; Interleukin-17; Interleukin-1beta; Male; Nose; Respiratory Sounds; Respiratory Tract Infections; Rhinovirus; Th17 Cells; Th2 Cells; Viral Load

There is evidence that the lung microbiome differs between patients with asthma and healthy humans, but the effect of environmental conditions and medication is unknown and difficult to study. Equine asthma is a naturally occurring chronic airway disease characterized by reversible airway inflammation and bronchoconstriction upon exposure to inhaled antigens. In the present study, we evaluated the effect that environmental conditions and disease status have on pulmonary, nasal, and oral microbiomes. Six asthmatic and six healthy horses were studied while at pasture ("low antigen exposure"), as well as when being housed indoors and fed good-quality hay ("moderate exposure") and poor-quality hay ("high exposure"). At each time point, lung function was recorded; BAL, oral, and nasal rinses were collected; and 16S rRNA gene sequencing was performed. Asthmatic horses developed airway obstruction and inflammation under moderate and high antigen exposure conditions, whereas nonasthmatic horses showed mild inflammation under high antigen exposure, without bronchoconstriction. Lung, oral, and nasal communities clustered by environmental condition, but only lung communities were different between healthy and asthmatic horses. The association between asthma and lung microbiome was strongest in horses under moderate antigen exposure. Pulmonary, oral, and nasal microbiomes are influenced by environmental conditions, but only the pulmonary microbiome differs between horses with and without asthma. This difference, seen mainly when airway inflammation was present in horses with asthma but not in control animals, suggests that the altered lung microbiome in asthma might not be inherent but coincident with inflammation.

Topics: Animals; Asthma; Bronchoalveolar Lavage Fluid; Cell Count; Cross-Over Studies; Environment; Female; Horse Diseases; Horses; Lung; Male; Microbiota; Mouth; Nose; Respiratory Function Tests

Allergic asthma is a lower respiratory tract disease of Th2 inflammation with multiple molecular mechanisms. The upper and lower airways can be unified by the concept of a united airway and, as such, gene expression studies of upper epithelial cells may provide effective surrogate biomarkers for the prognostic study of allergic asthma.. To identify surrogate biomarkers in upper airway epithelial cells for the prognostic study of allergic asthma.. Nasal epithelial cell gene expression in 40 asthmatic and 17 healthy control subjects were analyzed by weighted gene coexpression network analysis (WGCNA) to identify gene network modules and profiles in allergic asthma. Functional enrichment analysis was performed on the coexpression genes in certain highlighted modules.. A total of 13 coexpression modules were constructed by WGCNA from 2804 genes in nasal epithelial brushing samples of the 40 asthmatic and 17 healthy subjects. The number of genes in these modules ranged from 1086 (Turquoise module) to 45 (Salmon). Eight coexpression modules were found to be significantly correlated (P < 0.05) with two clinic traits, namely disease status, and severity. Four modules were positively correlated ( P < 0.05) with the traits and these, therefore, contained genes that are mostly overexpressed in asthma. Contrastingly, the four other modules were found to be negatively correlated with the clinic traits. Functional enrichment analysis of the positively correlated modules showed that one (Magenta) was mainly enriched in mast cell activation and degranulation; another (Pink) was largely involved in immune cell response; the third (Yellow) was predominantly enriched in transmembrane signal pathways; and the last (Blue) was mainly enriched in substructure components of the cells. The hub genes in the modules were KIT, KITLG, GATA2, CD44, PTPRC, and CFTR, and these were confirmed as having significantly higher expression in the nasal epithelial cells. Combining the six hub genes enabled a relatively high capacity for discrimination between asthmatics and healthy subjects with an area under the receiver operating characteristic (ROC) curve of 0.924.. Our findings provide a framework of coexpression gene modules from nasal epithelial brushing samples that could be used for the prognostic study of allergic asthma.

Topics: Adolescent; Adult; Aged; Area Under Curve; Asthma; Biomarkers; Cluster Analysis; Down-Regulation; Epithelial Cells; Female; Gene Ontology; Gene Regulatory Networks; Humans; Hypersensitivity; Male; Middle Aged; Nose; Prognosis; Quantitative Trait, Heritable; ROC Curve; Up-Regulation; Young Adult

Topics: Adult; Asthma; Humans; Nose; Staphylococcal Infections; Staphylococcus aureus

Despite the close linkage between rhinitis, chronic rhinosinusitis (CRS) and asthma, relevant biomarkers of both upper and lower airway inflammation are rare.. Patients with asthma (without upper airway disease [UAD; n = 24], with rhinitis [n = 25], CRS [n = 24], and nasal polyps [n = 2]), isolated rhinitis (n = 13), isolated CRS (n = 13), and 10 healthy controls were prospectively recruited. Fractional exhaled nitric oxide (NO) levels at 50 mL/s (FeNO. Asthma was associated with higher FeNO. Higher nasal NO levels reflect the presence of AR, irrespective of asthma concomitance. Higher FeNO

Topics: Adult; Aged; Asthma; Breath Tests; Exhalation; Female; Humans; Male; Middle Aged; Nasal Polyps; Nitric Oxide; Nose; Respiratory Function Tests; Rhinitis; ROC Curve; Sinusitis; Tomography, X-Ray Computed

Persistent or recurrent wheezing is a common indication for flexible bronchoscopy, as anatomic and infectious or inflammatory changes are highly prevalent. We sought to evaluate the prevalence of anatomic, infectious, and inflammatory disease in a cohort of children undergoing flexible bronchoscopy for wheezing or poorly controlled asthma.. We retrospectively reviewed all children <18 years old who underwent flexible bronchoscopy at our center from October 29, 2012-December 31, 2016 for the primary or secondary indication of wheezing (persistent, frequently recurring, or atypical) or poorly controlled asthma.. A total of 101 procedures were identified in 94 patients, aged 3 months to 18 years. Potential anatomic causes for wheezing identified in 45.7% of patients and inflammatory changes in 49.5% of procedures. This included the identification of a laryngeal cleft in 17% for which half required medical or surgical management. Tracheobronchomalacia was the most commonly identified anatomic lesion. Thirty children from this cohort had poorly controlled asthma. Among this subgroup, 54% had increased neutrophils on BAL and 30% had an anatomic contributor to wheezing, including one with a laryngeal cleft. Based on findings from flexible bronchoscopy, management changes made in 63.8% of patients. This included medication changes in 54 and surgical intervention in 9.. We conclude that transnasal flexible bronchoscopy has high yield in children with recurrent, persistent, or atypical wheezing and those with poorly controlled asthma. Laryngeal cleft has a reasonably high prevalence that warrants specific evaluation in this population.

Topics: Adolescent; Asthma; Bronchoscopy; Child; Child, Preschool; Congenital Abnormalities; Female; Humans; Infant; Larynx; Male; Nose; Prevalence; Recurrence; Respiratory Sounds; Retrospective Studies; Tracheobronchomalacia

Emerging studies suggest that enhanced glycolysis accompanies inflammatory responses. Virtually nothing is known about the relevance of glycolysis in patients with allergic asthma.. We sought to determine whether glycolysis is altered in patients with allergic asthma and to address its importance in the pathogenesis of allergic asthma.. We examined alterations in glycolysis in sputum samples from asthmatic patients and primary human nasal cells and used murine models of allergic asthma, as well as primary mouse tracheal epithelial cells, to evaluate the relevance of glycolysis.. In a murine model of allergic asthma, glycolysis was induced in the lungs in an IL-1-dependent manner. Furthermore, administration of IL-1β into the airways stimulated lactate production and expression of glycolytic enzymes, with notable expression of lactate dehydrogenase A occurring in the airway epithelium. Indeed, exposure of mouse tracheal epithelial cells to IL-1β or IL-1α resulted in increased glycolytic flux, glucose use, expression of glycolysis genes, and lactate production. Enhanced glycolysis was required for IL-1β- or IL-1α-mediated proinflammatory responses and the stimulatory effects of IL-1β on house dust mite (HDM)-induced release of thymic stromal lymphopoietin and GM-CSF from tracheal epithelial cells. Inhibitor of κB kinase ε was downstream of HDM or IL-1β and required for HDM-induced glycolysis and pathogenesis of allergic airways disease. Small interfering RNA ablation of lactate dehydrogenase A attenuated HDM-induced increases in lactate levels and attenuated HDM-induced disease. Primary nasal epithelial cells from asthmatic patients intrinsically produced more lactate compared with cells from healthy subjects. Lactate content was significantly higher in sputum supernatants from asthmatic patients, notably those with greater than 61% neutrophils. A positive correlation was observed between sputum lactate and IL-1β levels, and lactate content correlated negatively with lung function.. Collectively, these findings demonstrate that IL-1β/inhibitory κB kinase ε signaling plays an important role in HDM-induced glycolysis and pathogenesis of allergic airways disease.

Topics: Animals; Antigens, Dermatophagoides; Asthma; Cells, Cultured; Cohort Studies; Disease Models, Animal; Female; Glycolysis; Humans; Hypersensitivity; I-kappa B Proteins; Interleukin-1beta; Lactic Acid; Lung; Male; Mice; Middle Aged; Neutrophils; Nose; Proto-Oncogene Proteins; Pyroglyphidae; Respiratory Mucosa; RNA, Small Interfering; Signal Transduction; Sputum

Nasal microbiota may influence asthma pathobiology.. We sought to characterize the nasal microbiome of subjects with exacerbated asthma, nonexacerbated asthma, and healthy controls to identify nasal microbiota associated with asthma activity.. We performed 16S ribosomal RNA sequencing on nasal swabs obtained from 72 primarily adult subjects with exacerbated asthma (n = 20), nonexacerbated asthma (n = 31), and healthy controls (n = 21). Analyses were performed using Quantitative Insights into Microbial (QIIME); linear discriminant analysis effect size (LEfSe); Phylogenetic Investigation of Communities by Reconstruction of Unobserved States; and Statistical Analysis of Metagenomic Profiles (PICRUSt); and Statistical Analysis of Metagenomic Profiles (STAMP). Species found to be associated with asthma activity were validated using quantitative PCR. Metabolic pathways associated with differentially abundant nasal taxa were inferred through metagenomic functional prediction.. Nasal bacterial composition significantly differed among subjects with exacerbated asthma, nonexacerbated asthma, and healthy controls (permutational multivariate ANOVA, P = 2.2 × 10. Nasal microbiome composition differs in subjects with exacerbated asthma, nonexacerbated asthma, and healthy controls. The identified nasal taxa could be further investigated for potential mechanistic roles in asthma and as possible biomarkers of asthma activity.

Topics: Adolescent; Adult; Aged; Asthma; Bacteria; Child; Female; Humans; Male; Microbiota; Middle Aged; Nose; RNA, Ribosomal, 16S; Young Adult

Chronic rhinosinusitis with nasal polyp (CRSwNP) patients are often characterized by asthma comorbidity and a type-2 inflammation of the sinonasal mucosa. The mucosal microbiota has been suggested to be implicated in the persistence of inflammation, but associations have not been well defined. To compare the bacterial communities of healthy subjects with CRSwNP patients, we collected nasal swabs from 17 healthy subjects, 21 CRSwNP patients without asthma (CRSwNP-A), and 20 CRSwNP patients with co-morbid asthma (CRSwNP+A). We analysed the microbiota using high-throughput sequencing of the bacterial 16S rRNA. Bacterial communities were different between the three groups. Haemophilus influenzae was significantly enriched in CRSwNP patients, Propionibacterium acnes in the healthy group; Staphylococcus aureus was abundant in the CRSwNP-A group, even though present in 57% of patients. Escherichia coli was found in high amounts in CRSwNP+A patients. Nasal tissues of CRSwNP+A patients expressed significantly higher concentrations of IgE, SE-IgE, and IL-5 compared to those of CRSwNP-A patients. Co-cultivation demonstrated that P. acnes growth was inhibited by H. influenzae, E. coli and S. aureus. The nasal microbiota of healthy subjects are different from those of CRSwNP-A and CRSwNP+A patients. However, the most abundant species in healthy status could not inhibit those in CRSwNP disease.

Topics: Adult; Asthma; Bacteria; Bacterial Infections; Case-Control Studies; Chronic Disease; Dysbiosis; Female; Humans; Inflammation; Male; Middle Aged; Nasal Polyps; Nose; Rhinitis; Sinusitis

Perturbations to the composition and function of bronchial bacterial communities appear to contribute to the pathophysiology of asthma. Unraveling the nature and mechanisms of these complex associations will require large longitudinal studies, for which bronchoscopy is poorly suited. Studies of samples obtained by sputum induction and nasopharyngeal brushing or lavage have also reported asthma-associated microbiota characteristics. It remains unknown, however, whether the microbiota detected in these less-invasive sample types reflect the composition of bronchial microbiota in asthma.. Bacterial microbiota in paired protected bronchial brushings (BB; n = 45), induced sputum (IS; n = 45), oral wash (OW; n = 45), and nasal brushings (NB; n = 27) from adults with mild atopic asthma (AA), atopy without asthma (ANA), and healthy controls (HC) were profiled using 16S rRNA gene sequencing. Though microbiota composition varied with sample type (p < 0.001), compositional similarity was greatest for BB-IS, particularly in AAs and ANAs. The abundance of genera detected in BB correlated with those detected in IS and OW (r median [IQR] 0.869 [0.748-0.942] and 0.822 [0.687-0.909] respectively), but not with those in NB (r = 0.004 [- 0.003-0.011]). The number of taxa shared between IS-BB and NB-BB was greater in AAs than in HCs (p < 0.05) and included taxa previously associated with asthma. Of the genera abundant in NB, only Moraxella correlated positively with abundance in BB; specific members of this genus were shared between the two compartments only in AAs. Relative abundance of Moraxella in NB of AAs correlated negatively with that of Corynebacterium but positively with markers of eosinophilic inflammation in the blood and BAL fluid. The genus, Corynebacterium, trended to dominate all NB samples of HCs but only half of AAs (p = 0.07), in whom abundance of this genus was negatively associated with markers of eosinophilic inflammation.. Induced sputum is superior to nasal brush or oral wash for assessing bronchial microbiota composition in asthmatic adults. Although compositionally similar to the bronchial microbiota, the microbiota in induced sputum are distinct, reflecting enrichment of oral bacteria. Specific bacterial genera are shared between the nasal and the bronchial mucosa which are associated with markers of systemic and bronchial inflammation.

Topics: Adult; Asthma; Bronchi; Corynebacterium; Eosinophils; Female; Humans; Inflammation; Male; Microbiota; Middle Aged; Moraxella; Mouth Mucosa; Nose; RNA, Ribosomal, 16S; Sputum

Pediatric asthma is the most common chronic childhood disease in the USA, currently affecting ~ 7 million children. This heterogeneous syndrome is thought to encompass various disease phenotypes of clinically observable characteristics, which can be statistically identified by applying clustering approaches to patient clinical information. Extensive evidence has shown that the airway microbiome impacts both clinical heterogeneity and pathogenesis in pediatric asthma. Yet, so far, airway microbiotas have been consistently neglected in the study of asthma phenotypes. Here, we couple extensive clinical information with 16S rRNA high-throughput sequencing to characterize the microbiota of the nasal cavity in 163 children and adolescents clustered into different asthma phenotypes.. Our clustering analyses identified three statistically distinct phenotypes of pediatric asthma. Four core OTUs of the pathogenic genera Moraxella, Staphylococcus, Streptococcus, and Haemophilus were present in at least 95% of the studied nasal microbiotas. Phyla (Proteobacteria, Actinobacteria, and Bacteroidetes) and genera (Moraxella, Corynebacterium, Dolosigranulum, and Prevotella) abundances, community composition, and structure varied significantly (0.05 < P ≤ 0.0001) across asthma phenotypes and one of the clinical variables (preterm birth). Similarly, microbial networks of co-occurrence of bacterial genera revealed different bacterial associations across asthma phenotypes.. This study shows that children and adolescents with different clinical characteristics of asthma also show different nasal bacterial profiles, which is indicative of different phenotypes of the disease. Our work also shows how clinical and microbial information could be integrated to validate and refine asthma classification systems and develop biomarkers of disease.

Topics: Adolescent; Asthma; Child; Female; Haemophilus; High-Throughput Nucleotide Sequencing; Humans; Male; Microbiota; Moraxella; Nasopharynx; Nose; RNA, Ribosomal, 16S; Staphylococcus; Streptococcus

Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.. Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014. For each participant, we interviewed parents, reviewed medical records, and tested nasal and throat swabs for EV-D68 using real-time reverse- transcription polymerase chain reaction assay.. EV-D68 infection was detected in 51 of 207 (25%) inpatients and 58 of 505 (11%) ED patients. Rates of EV-D68 hospitalization and ED visit were 1.3 (95% confidence interval [CI], 1.0-1.6) and 8.4 per 1000 children <13 years of age, respectively. Preexisting asthma was associated with EV-D68 infection (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1). Compared with other ARI, children with EV-D68 were more likely to be admitted from the ED (P ≤ .001), receive supplemental oxygen (P = .001), and require intensive care unit admission (P = .04); however, mechanical ventilation was uncommon (2/51 inpatients; P = .64), and no deaths occurred.. During the 2014 EV-D68 epidemic, high rates of pediatric hospitalizations and ED visits were observed. Children with asthma were at increased risk for medically attended EV-D68 illness. Preparedness planning for a high-activity EV-D68 season in the United States should take into account increased healthcare utilization, particularly among children with asthma, during the late summer and early fall.

Topics: Acute Disease; Adolescent; Asthma; Child; Child, Preschool; Disease Outbreaks; Enterovirus D, Human; Enterovirus Infections; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Male; Medical Records; Nose; Ohio; Pharynx; Prospective Studies; Real-Time Polymerase Chain Reaction; Respiratory Tract Infections; Seasons

Patients with asthma and healthy controls differ in bacterial colonization of the respiratory tract. The upper airways have been shown to reflect colonization of the lower airways, the actual site of inflammation in asthma, which is hardly accessible in population studies.. We sought to characterize the bacterial communities at 2 sites of the upper respiratory tract obtained from children from a rural area and to relate these to asthma.. The microbiota of 327 throat and 68 nasal samples from school-age farm and nonfarm children were analyzed by 454-pyrosequencing of the bacterial 16S ribosomal RNA gene.. Alterations in nasal microbiota but not of throat microbiota were associated with asthma. Children with asthma had lower α- and β-diversity of the nasal microbiota as compared with healthy control children. Furthermore, asthma presence was positively associated with a specific operational taxonomic unit from the genus Moraxella in children not exposed to farming, whereas in farm children Moraxella colonization was unrelated to asthma. In nonfarm children, Moraxella colonization explained the association between bacterial diversity and asthma to a large extent.. Asthma was mainly associated with an altered nasal microbiota characterized by lower diversity and Moraxella abundance. Children living on farms might not be susceptible to the disadvantageous effect of Moraxella. Prospective studies may clarify whether Moraxella outgrowth is a cause or a consequence of loss in diversity.

Topics: Asthma; Bacteria; Child; DNA, Bacterial; Farms; Female; Humans; Male; Microbiota; Nose; Pharynx; RNA, Ribosomal, 16S

The increasing prevalence of allergies and asthma has been reported. However, the progression of the prevalence of allergy (the "allergic diathesis progression") has not been examined over time from skin test positivity to oculonasal symptoms to the development of asthma.. To investigate the change in the prevalences and associations of positive skin test reactions, oculonasal symptoms, and asthma during the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III, respectively).. Data collected during NHANES II and III were used. The prevalence and associations of positive skin test reactions, oculonasal symptoms, and asthma and the linear trend of oculonasal symptoms and asthma prevalence across different cumulative positive skin test reactions were calculated for each NHANES period.. From NHANES II to NHANES III, the prevalence of asthma doubled (2 times) and increased for positive skin test reactions (2.2 times), oculonasal symptoms (3.3 times), and concurrence of asthma, oculonasal symptoms, and positive skin test reactions (5.3 times). People were sensitive to an increasing number of allergens. Positive skin test reactions increased from 0.2% (NHANES II) to 2.7% (NHANES III) for people allergic to all 6 allergens.. Despite some methodologic differences in skin tests across NHANES II and III, this study demonstrated significant increases in allergen sensitivities (prevalence and number of allergens), oculonasal symptoms, and asthma over a 20-year course, indicating that increased sensitivity led to increased allergic symptoms and asthma during the 20 years from NHANES II to NHANES III.

Topics: Adolescent; Adult; Allergens; Asthma; Child; Eye; Humans; Middle Aged; Nose; Nutrition Surveys; Prevalence; Skin Tests; United States; Young Adult

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of asthma in this group is largely unknown.. To determine the frequency of asthma in patients with CRSwNP treated in a primary care (PC) setting who have never been referred for surgery and to compare this with ESS patients.. Fifty-seven patients with CRSwNP who had never undergone ESS were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests (reversibility to β2-agonist, peak expiratory flow variability, and mannitol challenge) were performed. Findings were compared with our previously published data from patients with CRSwNP referred for surgery.. Asthma was diagnosed in 25 patients (44%) based on respiratory symptoms and a positive asthma test; of these, 12 (48%) had undiagnosed asthma prior to study onset. Furthermore, when using the same methods, we found a lower frequency of asthma in PC patients compared with ESS patients (44% versus 65%, p = 0.04).. A high prevalence of asthma in PC patients with CRSwNP was found. Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma specialists.

Topics: Adult; Aged; Asthma; Chronic Disease; Denmark; Ear; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Pharynx; Prevalence; Primary Health Care; Prospective Studies; Rhinitis; Sinusitis; Young Adult

Topics: Asthma; Cannula; Humans; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency

Rhinitis and asthma share similar immunopathological features. Rhinomanometry is an important test used to assess nasal function and spirometry is an important tool used in asthmatic children. The degree to which the readouts of these tests are correlated has yet to be established. We sought to clarify the relationship between rhinomanometry measurements, fractional exhaled nitric oxide (FeNO), and spirometric measurements in asthmatic children.. Patients' inclusion criteria: age between 5 and 18 years, history of asthma with nasal symptoms, and no anatomical deformities. All participants underwent rhinomanometric evaluations and pulmonary function and FeNO tests.. Total 84 children were enrolled. By rhinomanometry, the degree of nasal obstruction was characterized as follows: (1) no obstruction in 33 children, (2) slight obstruction in 29 children, and (3) moderate obstruction in 22 children. FeNO was significantly lower in patients without obstruction than those with slight or moderate obstruction. Dividing patients according to ATS Clinical Practice Guidelines regarding FeNO, patients < 12 years with FeNO > 20 ppb had a lower total nasal airflow rate than those with FeNO < 20 ppb. Patients ≥ 12 years with FeNO > 25 ppb had a lower total nasal airflow rate than those with FeNO < 25 ppb.. Higher FeNO was associated with a lower nasal airflow and higher nasal resistance. This supports a relationship between upper and lower airway inflammation, as assessed by rhinomanometry and FeNO. The results suggest that rhinomanometry may be integrated as part of the functional assessment of asthma.

Topics: Adolescent; Asthma; Child; Child, Preschool; Exhalation; Female; Humans; Immunoglobulin E; Male; Nitric Oxide; Nose; Pulmonary Ventilation; Rhinitis, Allergic; Rhinomanometry; Spirometry; Surveys and Questionnaires

Severe asthma (SA) is associated with neutrophil recruitment and T helper (TH )17 chemokine overexpression in bronchial biopsies. We aimed to evaluate IL-17A and IL-17F expression in nasal/bronchial lamina propria of atopic mild-to-severe asthmatics and controls in relation to neutrophilia and asthma exacerbations. Cryostat sections of nasal/bronchial biopsies obtained from 14 SA and 14 mild asthma (MA) stable atopic patients with rhinitis, and seven healthy controls were analyzed by immunohistochemistry for neutrophils, IL-17A and IL-17F expression. Atopic SA showed an increase in asthma exacerbations number, IL-17F and IL-17A expression in nasal/bronchial lamina propria compared to MA and controls, and a higher expression of bronchial neutrophils in SA compared to MA and controls. In all asthmatics, significant relationships were found between bronchial IL-17F and neutrophils/FEV1 , nasal IL-17F and bronchial neutrophil/IL-17 markers and between the latter and exacerbations, suggesting that nasal IL-17F might be informative on bronchial IL17-driven neutrophilia in atopic SA.

Topics: Adult; Asthma; Biopsy; Bronchi; Case-Control Studies; Disease Progression; Female; Forced Expiratory Volume; Humans; Hypersensitivity, Immediate; Interleukin-17; Male; Middle Aged; Nasal Mucosa; Neutrophil Infiltration; Neutrophils; Nose; Respiratory Mucosa; Risk Factors

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy.. Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland.. A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III-IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2.. The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III-IV polyposis had a significant adverse effect on long-term outcome.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Drug Hypersensitivity; Female; Follow-Up Studies; Forecasting; Humans; Male; Nasal Polyps; Natural Orifice Endoscopic Surgery; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Retrospective Studies; Tomography, X-Ray Computed

Topics: Aged; Antigens, Fungal; Asthma; Blastomyces; Blastomycosis; Carcinoma, Squamous Cell; Delayed Diagnosis; Diagnosis, Differential; Dyspnea; Glucocorticoids; Humans; Lung; Male; Nose; Nose Neoplasms; Pulmonary Embolism; Radiography; Venous Thrombosis

Staphylococcus aureus nasal colonization is a risk factor for surgical site infection. We conducted a retrospective case-control study of 1,708 consecutively enrolled patients to identify criteria that places orthopaedic surgery patients undergoing spine and total joint arthroplasty surgery at risk for nasal colonization by MRSA and MSSA. Multivariate analysis showed obesity and asthma as significant risk factors for MRSA colonization. The identification of these two risk factors for MRSA colonization may help decolonization programs target patients with these factors for treatment prior to surgery, which could potentially lead to reductions in the rates of surgical site infections.

Topics: Arthroplasty, Replacement; Asthma; Databases, Factual; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Multivariate Analysis; Nose; Obesity; Odds Ratio; Orthopedic Procedures; Retrospective Studies; Risk Factors; Sex Factors; Spine; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; White People

Mechanisms underlying the development of virus-induced asthma exacerbations remain unclear. To investigate if epigenetic mechanisms could be involved in virus-induced asthma exacerbations, we undertook DNA methylation profiling in asthmatic and healthy nasal epithelial cells (NECs) during Human Rhinovirus (HRV) infection in vitro.. Global and loci-specific methylation profiles were determined via Alu element and Infinium Human Methylation 450 K microarray, respectively. Principal components analysis identified the genomic loci influenced the most by disease-status and infection. Real-time PCR and pyrosequencing were used to confirm gene expression and DNA methylation, respectively.. HRV infection significantly increased global DNA methylation in cells from asthmatic subjects only (43.6% to 44.1%, p = 0.04). Microarray analysis revealed 389 differentially methylated loci either based on disease status, or caused by virus infection. There were disease-associated DNA methylation patterns that were not affected by HRV infection as well as HRV-induced DNA methylation changes that were unique to each group. A common methylation locus stood out in response to HRV infection in both groups, where the small nucleolar RNA, H/ACA box 12 (SNORA12) is located. Further analysis indicated that a relationship existed between SNORA12 DNA methylation and gene expression in response to HRV infection.. We describe for the first time that Human rhinovirus infection causes DNA methylation changes in airway epithelial cells that differ between asthmatic and healthy subjects. These epigenetic differences may possibly explain the mechanism by which respiratory viruses cause asthma exacerbations.

Topics: Adult; Asthma; Demography; DNA Methylation; Epithelial Cells; Female; Gene Expression Regulation; Genetic Loci; Genome, Human; Humans; Male; Nose; Oligonucleotide Array Sequence Analysis; Picornaviridae Infections; Principal Component Analysis; Respiratory Function Tests; Rhinovirus; Young Adult

Respiratory activity may have an influence on craniofacial development and interact with genetic and environmental factors. It has been suggested that certain medical conditions such as asthma have an influence on face shape. The aim of the study is to investigate whether facial shape is different in individuals diagnosed as having asthma compared with controls. Study design included observational longitudinal cohort study. Asthma was defined as reported wheezing diagnosed at age 7 years and 6 months. The cohort was followed to 15 years of age as part of the Avon Longitudinal Study of Parents and Children. A total of 418 asthmatics and 3010 controls were identified. Three-dimensional laser surface facial scans were obtained. Twenty-one reproducible facial landmarks (x, y, z co-ordinates) were identified. Average facial shells were created for asthmatic and non-asthmatic males and females to explore surface differences. The inter-ala distance was 0.4mm wider (95% CI) and mid-face height was 0.4mm (95% CI) shorter in asthmatic females when compared with non-asthmatic females. No facial differences were detected in male subjects. Small but statistically significant differences were detected in mid-face height and inter-ala width between asthmatic and non-asthmatic females. No differences were detected in males. The lack of detection of any facial differences in males may be explained by significant facial variation as a result of achieving different stages of facial growth due to pubertal changes, which may mask any underlying condition effect.

Topics: Anatomic Landmarks; Asthma; Body Mass Index; Cephalometry; Child; Cohort Studies; Eye; Face; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Lip; Longitudinal Studies; Male; Maxillofacial Development; Nasal Cartilages; Nose; Vertical Dimension

Asthma is a chronic inflammatory disease characterized by bronchospasms accompanied with frequent coughing, the pathogenesis of which is not clear. In healthy adults deep inspirations (DIs) provide a protective effect against bronchoconstriction triggered by methacholine inhalation, which correlates with the number of accompanying cough efforts. The aim was to study the effect of deep nasal inspirations representing the voluntary equivalent of the sniff-like aspiration reflex on the capsaicin-induced cough in children with mild asthma. The cough reflex sensitivity to capsaicin was determined using a compressed air-driven nebulizer in 21 children (8 girls and 13 boys of median age 13.3 year) suffering from mild asthma (FEV(1)∼80%). The effect of five previous DIs through the nose was examined on the elicitability of two and five or more cough efforts (C2, C5). Under control conditions, the concentration of 20.86 (14.58-29.8) μmol/l of capsaicin provoked two cough efforts (C2). After five DIs similar reaction required significantly higher concentrations of capsaicin: 29.02 (18.88-44.6) μmol/l; P=0.016. Five or more cough efforts (C5) were not significantly changed after previous DIs 161.49 (77.31-337.33) μmol/l and without DIs 141.52 (68.77-291); P=0.54. A series of five deep inspirations decreases the cough reflex sensitivity to evoke two efforts (C2) in children with mild asthma. The inhibitory effect of similar DIs disappeared after repeated applications of increasing doses of capsaicin, aiming to evoke five or more cough efforts, suggesting a reflex character of protective effect of DIs.

Topics: Adolescent; Asthma; Capsaicin; Cough; Female; Humans; Inhalation; Male; Nose; Reflex

Parasympathetic nerves control the symptoms and inflammation of allergic diseases primarily by signaling through peripheral muscarinic receptors. Parasympathetic signaling targets classic effector tissues such as airway smooth muscle and secretory glands and mediates acute symptoms of allergic disease such as airway narrowing and increased mucus secretion. In addition, parasympathetic signaling modulates inflammatory cells and non-neuronal resident cell types such as fibroblasts and smooth muscle contributing to chronic allergic inflammation and tissue remodeling. Importantly, muscarinic antagonists are experiencing a rebirth for the treatment of asthma and may be useful for treating other allergic diseases.

Topics: Animals; Asthma; Eye; Fibroblasts; Humans; Hypersensitivity; Intestines; Lung; Muscarinic Antagonists; Muscle, Smooth; Nose; Parasympathetic Nervous System; Receptors, Muscarinic; Signal Transduction; Skin

Asthmatics are more susceptible to influenza infections, yet mechanisms mediating this enhanced susceptibility are unknown. Influenza virus hemagglutinin (HA) protein binds to sialic acid residues on the host cells. HA requires cleavage to allow fusion of the viral HA with host cell membrane, which is mediated by host trypsin-like serine protease. We show data here demonstrating that the protease:antiprotease ratio is increased in the nasal mucosa of asthmatics and that these changes were associated with increased proteolytic activation of influenza. These data suggest that disruption of the protease balance in asthmatics enhances activation and infection of influenza virus.

Topics: Adult; Animals; Asthma; Case-Control Studies; Dogs; Female; Hemagglutinin Glycoproteins, Influenza Virus; Humans; Hypersensitivity, Immediate; Influenza A Virus, H1N1 Subtype; Madin Darby Canine Kidney Cells; Male; Nasal Lavage Fluid; Nose; Secretory Leukocyte Peptidase Inhibitor; Serine Endopeptidases; Virus Replication; Young Adult

A new and potentially more pathogenic group of human rhinovirus (HRV), group C (HRVC), has recently been discovered. We hypothesised that HRVC would be present in children with acute asthma and cause more severe attacks than other viruses or HRV groups. Children with acute asthma (n = 128; age 2-16 yrs) were recruited on presentation to an emergency department. Asthma exacerbation severity was assessed, and respiratory viruses and HRV strains were identified in a nasal aspirate. The majority of the children studied had moderate-to-severe asthma (85.2%) and 98.9% were admitted to hospital. HRV was detected in 87.5% and other respiratory viruses in 14.8% of children, most of whom also had HRV. HRVC was present in the majority of children with acute asthma (59.4%) and associated with more severe asthma. Children with HRVC (n = 76) had higher asthma severity scores than children whose HRV infection was HRVA or HRVB only (n = 34; p = 0.018), and all other children (n = 50; p = 0.016). Of the 19 children with a non-HRV virus, 13 had HRV co-infections, seven of these being HRVC. HRVC accounts for the majority of asthma attacks in children presenting to hospital and causes more severe attacks than previously known HRV groups and other viruses.

Topics: Acute Disease; Adolescent; Asthma; Child; Child, Preschool; Disease Progression; Female; Humans; Male; Nasal Mucosa; Nose; Picornaviridae Infections; Rhinovirus; Severity of Illness Index

Large particles entering the nose are collected by nasal hair present in the anterior nares. Increased hair density provides an improvement in the filtering efficiency of the nose, while reduced amounts of nasal hair cause a decrease in its efficiency. The amount of nasal hair can vary between individuals, which can make a difference in the filtering efficiency of the nose. Reduced filter function of the nose leads to increased exposure of the airways to allergens. The aim of this study was to determine the effect of nasal hair density on the risk of developing asthma in seasonal rhinitis (SR) patients.. A standard questionnaire was filled in, and physical examination and allergy tests were performed in 233 patients. Patients were divided into 3 groups according to the amount of nasal hair [few (few or none), moderate and many]. The association between asthma and nasal hair density was assessed.. Asthma was detected in 75 patients (32.2%), and of these, 45 (60%) also had pollen asthma. The rate of asthma was 44.7, 26.2 and 16.7% in the few, moderate and many groups, respectively (p = 0.002). Few nasal hairs significantly increased the risk of developing asthma [odds ratio (95% confidence interval): few, reference; moderate, 0.41 (0.21-0.78); many, 0.19 (0.06-0.55); p = 0.002].. Our findings suggest that the amount of nasal hair providing a nose filtration function has a protective effect on the risk of developing asthma in SR patients. To the best of our knowledge, this is the first report on this subject in the literature.

Topics: Adolescent; Adult; Aged; Allergens; Animals; Asthma; Female; Hair; Humans; Immunoglobulin E; Male; Middle Aged; Nose; Rhinitis, Allergic, Seasonal; Risk Factors; Skin Tests; Surveys and Questionnaires; Young Adult

The increasing prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) strains together with their disease impact on hospital patients and individuals in the community has posed a major challenge to healthcare workers. This study examined the prevalence of S. aureus nasal carriage, antimicrobial susceptibility patterns, and possible risk factors in the community. Of 500 studied subjects (aged from 6 to 65 years) in Lebanon, the overall S. aureus nasal carriage rate was 38.4%, the highest (57.1%) being in children aged 6-10 years. Only eight individuals (1.6%) were carriers of MRSA. Risk factors for S. aureus nasal colonization were male gender, young age, contact with healthcare workers, use of needle injections, and having asthma. A significant decrease in colonization rate was associated with nasal wash with water, use of nasal sprays, and the presence of acne. These findings may assist in better understanding of control measures to decrease nasal colonization with S. aureus in Lebanon and elsewhere.

Topics: Adolescent; Adult; Age Factors; Aged; Asthma; Carrier State; Child; Community-Acquired Infections; Female; Health Personnel; Humans; Injections; Lebanon; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Prevalence; Risk Factors; Sex Factors; Staphylococcal Infections; Staphylococcus aureus; Young Adult

It is noteworthy that there is a clear clinical, epidemiological and pathophysiological association between upper and lower airway inflammation in rhinitis and asthma.. The aim of this study was to compare the eosinophil counts in induced sputum and nasal lavage fluids in asthma, checking their association and the accuracy of nasal eosinophilia as a predictor of sputum eosinophilia by a cross-sectional study.. The clinical evaluation, asthma control questionnaire (ACQ), pre- and post-bronchodilator spirometry, nasal and sputum sample was performed. The nasal eosinophilia was analysed by a receiver operating curve and logistic regression model.. In 140 adults, the post-bronchodilator forced expiratory volume in 1 s (FEV(1)) did not differ between patients with or without sputum eosinophilia (0.18). After adjusted for upper airway symptoms, age, ACQ score and post-bronchodilator FEV(1), sputum eosinophilia was associated with 52 times increase in odds of nasal eosinophilia, whereas each 1% increase in bronchodilator response was associated with 7% increase in odds of nasal eosinophilia.. This study brings further evidence that upper airway diseases are an important component of the asthma syndrome. Furthermore, monitoring of nasal eosinophilia by quantitative cytology may be useful as a surrogate of sputum cytology in as a component of composite measurement for determining airway inflammation.

Topics: Administration, Intranasal; Adult; Asthma; Cross-Sectional Studies; Eosinophilia; Eosinophils; Female; Humans; Inflammation; Leukocyte Count; Male; Middle Aged; Nasal Lavage Fluid; Nose; Sputum

Topics: Adult; Asthma; Body Piercing; Diagnosis, Differential; Female; Follow-Up Studies; Foreign-Body Migration; Humans; Intestine, Small; Nose; Radiography, Abdominal; Radiography, Thoracic

Topics: Asthma; Eosinophilia; Eosinophils; Humans; Inflammation; Leukocyte Count; Lung; Nasal Lavage Fluid; Nose; Sputum

The guidelines of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) for standardized measurements of exhaled nitric oxide (NO) state that for online measurements the inhaled air should be free of NO. As it is not always possible to create an NO-free environment, inhalation through an NO-scrubber is used. To describe the relationship between ambient NO and measurements of fractional exhaled NO (FENO) and nasal NO (nNO) investigated according to the ATS-ERS guidelines in a large population of children. The present work makes use of data collected during the 8-yr follow-up of the Dutch PIAMA birth cohort study. FENO and nNO were measured in three hospitals in a total of 1005 children with a NIOX chemiluminescence analyser. In two hospitals, almost half of the measured ambient NO levels exceeded 5 p.p.b. Maximum levels were >100 p.p.b. in all hospitals. Despite its large variation, ambient NO did not have an effect on FENO, but it did have a significant impact on nNO in two of the three centres. The currently recommended technique including inhalation through an NO scrubber effectively deals with variable levels of ambient NO on FENO. In contrast, ambient NO has an effect on measurements of nNO.

Topics: Asthma; Breath Tests; Child; Exhalation; Female; Guideline Adherence; Humans; Luminescent Measurements; Male; Nitric Oxide; Nose; Rhinitis, Allergic, Seasonal

To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis.. A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses.. Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis.. In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.

Topics: Acute Disease; Asthma; Ear; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Nose; Pharynx; Physical Examination; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Between the upper and the lower respiratory tracts exists a link. Numerous epidemiological, immunological studies and clinical observations suggest the pathogenic unity of the upper and lower airways. The most important observations regarding the nose-lung interaction is rhinitis and asthma. The inflammatory process in the nose is the same as in the bronchi, clinically defined as rhinosinusitis, nasal polyps, asthma, bronchial hyperreactivity, allergy, viral infections. The strict link between the rhinosinusitis and asthma implies new possibility of influencing one of the two complaints by treating the other one with an integrated therapy (pharmacotherapy, endonasal microsurgery).

Topics: Asthma; Bronchi; Bronchial Hyperreactivity; Humans; Nose; Respiratory System; Rhinitis

Because both allergic rhinitis and asthma are caused by eosinophilic airway inflammation, using the same method to measure the eosinophilic inflammation of both the upper and lower airway would be advantageous. The levels of nitric oxide in exhaled air (FeNO) and nasal air (nNO) are useful as noninvasive markers of eosinophilic airway inflammation. Although the off-line method of measuring these parameters is easier and more useful than the on-line method, studies using the off-line method are rare in Japan.. In Study 1, we measured the levels of nNO and FeNO in 9 healthy controls and 9 subjects with allergic rhinitis, to validate the methodology for using the off-line method to measure nNO. In Study 2, we measured the nNO and FeNO levels of and performed spirometry on 69 stable asthmatics treated with inhaled corticosteroid.. In Study 1, nNO levels were significantly increased in patients with allergic rhinitis compared with healthy subjects (31.0 [20.8 to 41.2] versus 7.4 [0.0 to 14.8] ppb {median [95% confidence interval]}, p=0.018). The 69 patients with asthma that comprised the study population in Study 2 were classified as asthmatics with rhinitis (treatment-naïve, n=14; treated with antiallergic drugs, n=11; treated with intranasal corticosteroid, n=19) and asthmatics without rhinitis (n=15). Although FeNO did not differ among groups, nNO was significantly increased in treatment-naïve asthmatics with rhinitis compared with patients with asthma only (26.5 [17.1 to 35.9] versus 8.0 [-1.1 to 17.1] ppb, p=0.033).. nNO levels measured by the off-line method are useful markers of allergic rhinitis.

Topics: Adult; Air; Asthma; Female; Humans; Male; Middle Aged; Nitric Oxide; Nose; Rhinitis, Allergic, Perennial; Spirometry

Staphylococcus aureus skin colonization in atopic dermatitis (AD) patients exacerbates disease activity. Nasal and throat S. aureus carriage may be also implicated in the clinical course of allergic rhinitis and asthma. The aim of the study was to evaluate the frequency of skin, nasal, throat S. aureus colonization in patients with AD and asthma and assess if presence of this bacteria on the skin may be related with degree of sensitization.. Swabs for microbiological analysis were taken from affected skin, anterior nares and throat from 40 children with AD, 59 children with asthma and 56 healthy controls. Following lymphocyte subsets: CD3+, CD4+, CD8+, CD3+CD25+, CD4+CD25+ were measured using flow cytometry.. Nasal and throat S. aureus colonization was more frequent in atopic children. S. aureus was found in the skin lesions in 97.5% examined children with AD. Percentage of CD8+ was decreased but the number of CD4+, and CD4+CD25T+ cells was elevated compared with healthy. Total IgE and sIgE Der. pteronyssinus and Der. farinae as well SPT (Skin Prick Test) wheel size were higher in AD children compared to asthma. SCORAD was correlated with total and sIgE (mite, pollen) and number of S. aureus and increasing skin reactivity skin. The degree of sensitization was correlated with patient's age, duration of AD and asthma and number of CD3+, CD4+ and percentage of CD4+CD25+ only in AD patients. Severity of asthma was correlated with FEV1 and total IgE.. Staphylococcus aureus skin colonization in AD children increases disease activity and degree of sensitization measured by SPT wheel size and results in imbalance of peripheral blood T cells.

Topics: Asthma; Child; Dermatitis, Atopic; Female; Humans; Immunoglobulin E; Lymphocyte Subsets; Male; Nose; Pharynx; Rhinitis; Skin; Skin Tests; Staphylococcal Skin Infections; Staphylococcus aureus

Nasal breathing provides a protective influence against exercise-induced asthma. We hypothesized that enforced oral breathing in resting mild asthmatic subjects may lead to a reduction in lung function.. Asymptomatic resting mild asthmatic volunteers (n = 8) were instructed to breathe either nasally only (N; tape over lips) or orally only (O; nose clip) for 1 h each, on separate days. Lung function (% predicted FEV(1)) was measured using standard spirometry at baseline and every 10 min for 1 h. 'Difficulty in breathing' was rated using a Borg scale at the conclusion of the N and O periods.. Baseline FEV(1) on the N (101.2 +/- 3.8% predicted) and O (102.7 +/- 3.9% predicted) days was not significantly different (P > 0.3). At 60 min, FEV(1) on the O day (96.5 +/- 4.1% predicted) was significantly less than on the N day (101.0 +/- 3.5% predicted; P < 0.009). On the N day, FEV(1) did not change with time (P > 0.3), whereas on the O day, FEV(1) fell progressively (slope = -0.06 +/- 0.01% FEV(1)/min, P < 0.0001; linear mixed effects modelling). Three subjects experienced coughing/wheezing at the end of the O day but none experienced symptoms at the end of the N day. Subjects perceived more 'difficulty breathing in' at the end of the O day (1.5 +/- 0.4 arbitrary units) than on the N day (0.4 +/- 0.3 arbitrary unit; P < 0.05).. Enforced oral breathing causes a decrease in lung function in mild asthmatic subjects at rest, initiating asthma symptoms in some. Oral breathing may play a role in the pathogenesis of acute asthma exacerbations.

Topics: Adult; Asthma; Female; Forced Expiratory Volume; Humans; Linear Models; Mouth; Nose; Respiration; Spirometry

hBoV, a recently discovered parvovirus, can be present in the respiratory tract of patients with acute respiratory diseases (ARD), but its etiologic involvement in the underlying diseases is still uncertain.. To determine in a retrospective study, the prevalence of hBoV, compared with common respiratory viruses (RV), in respiratory specimens from patients with ARD.. A total of 335 specimens obtained over 7 years were examined. Two hundred were nasal swabs from infants hospitalized for ARD, 84 were nasal swabs or bronchoalveolar lavages from adults with pneumonia, bronchopneumonia or asthma, and 51 were nasal swabs from healthy children.. The overall rate of hBoV detection in specimens from infants with ARD, which was 4.5%, varied slightly from year to year, except for the period 2000-2002, when no specimen was positive. Unlike other RV, no seasonal variation in hBoV incidence was noted. Infants with hBoV infection suffered either from bronchiolitis or from bronchopneumonia and 5 out of 9 cases yielded no co-infecting viral pathogen. Only one sample from an adult was hBoV positive. None of the nasal swabs from healthy subjects tested hBoV-positive.. The findings indicate that hBoV can cause ARD in infants.

Topics: Acute Disease; Adolescent; Adult; Aged; Asthma; Bocavirus; Bronchoalveolar Lavage Fluid; Bronchopneumonia; Child; Child, Preschool; DNA, Viral; Female; Humans; Infant; Italy; Male; Middle Aged; Molecular Sequence Data; Nose; Parvoviridae Infections; Phylogeny; Pneumonia; Prevalence; Respiratory Tract Diseases; Retrospective Studies; Seasons; Sequence Analysis, DNA

Topics: Adult; Anesthesia, General; Asthma; Bronchial Spasm; Cholinesterase Inhibitors; Humans; Male; Nasal Septum; Neostigmine; Nose

The relationship among inhaled allergen exposure, sensitization, and asthma severity is unknown.. To investigate the relationship among personal allergen exposure, reservoir dust allergen concentrations, and physiological measures of asthma severity; to examine the numbers of particles inspired that react with autologous IgE and IgG4.. A total of 117 patients with asthma wore 5 nasal air samplers (NASs) at home: 1 each for exposure to mite, cat and dog allergens, NAS-IgE, and NAS-IgG4. NASs were processed by HALOgen assay for allergen measurement and incubated with autologous serum for detection of NAS-IgE and NAS-IgG4. Reservoir allergen concentrations were measured by ELISA. Subjects' asthma severity was ascertained by measurement of lung function, exhaled nitric oxide, and nonspecific bronchial reactivity to histamine.. Nasal air sampler counts correlated with reservoir concentrations for cat (r=0.31; P=.001) and dog (r=0.20; P=.03) but not mite allergen (r=0.001; P=1.0). There was no significant relationship between sensitization with exposure measured by NAS to any allergen and PD20FEV1 (F[3,60]=1.60; P=.20); however, sensitization with exposure in dust reservoirs had significant effects on PD20FEV1 for any allergen (F[3,59]=3.12; P=.03), cat (F[3,59]=3.77; P=.01), and mite (F[3,59]=2.78; P=.05), but not dog (F[3,59]=1.06; P=.37). We repeated the analysis with separate variables for sensitization and exposure, controlling for the confounders; sensitization but not exposure conferred lower PD20FEV1 values. However, increasing cat allergen exposure was associated with improving bronchial reactivity in not cat-sensitized patients. NAS-IgE and NAS-IgG4 counts bore no relationship to any measure of asthma severity.. Nasal air samplers confer no advantage over reservoir dust analysis for studies of asthma severity.. In common with other measures of exposure, single nasal air samples do not provide a useful measure of home allergen exposure for the individual patient with allergic asthma.

Topics: Adolescent; Adult; Aged; Air Pollution, Indoor; Allergens; Animals; Asthma; Bronchial Hyperreactivity; Cats; Dogs; Dust; Environmental Monitoring; Female; Housing; Humans; Immunoglobulin E; Immunoglobulin G; Inhalation Exposure; Male; Middle Aged; Nose; Pyroglyphidae; Severity of Illness Index

Aspirin-induced asthma (AIA) is a syndrome characterized by intolerance to aspirin (ASA), nasal polyps and bronchial asthma, the metabolic shift of arachidonic acid towards the lipoxygenase pathway and hyper-production of cysteinyl-leukotrienes (cys-LTs) being the current pathogenetic hypothesis. The research for both sensitive indicators and safe diagnostic tests is still attracting. Aim of the study was to measure changes in urinary LTE4 excretion and in nasal function (Resistance-Req, and Volume-Vol, assessed by acoustic rhinomanometry (AR)) following a nasal provocation test (NPT) with ASA:LTE4 measurements have been never previously used to our knowledge for assessing nasal responsiveness to ASA.. After written consent, 118 mild-to-moderate asthmatics (48 males, mean age 41.8 years+/-11.9SD, range 25-70 years; basal FEV1=80.1% pred.+/-5.8SD) underwent NPT by nasal instillation of ASA (total maximal dose 25 mg). Spirometry, acoustic rhinomanometry (AR; TM Hood Lab., USA) and urinary LTE4 (pg/mg creatinine; Cayman Chemical, MI, USA) were measured in baseline and 2h after the ASA challenge.. t-Test between means+/-sd, assuming P<0.05, and linear regression between all variables considered.. In 67 ASA-intolerant asthmatics, FEV1 did not change significantly following NPT (81.7% pred.+/-5.1SD in baseline, 80.5% pred.+/-4.1 after NPT, P=ns) even in the presence of a significant decrease of Vol (11.3 cm3+/-4.1SD in baseline, 5.9 cm3+/-4.2SD after NPT, P=0.003), a substantial increase of Req (0.88 cmH2O/l/min+/-0.11SD in baseline, 2.41 cmH2O/l/min+/-0.77 after NPT, P=0.002), and urinary LTE4 excretion (433.0 pg/mg+/-361.7 in bsln, 858.0 pg/mg+/-471.6 90 min after NPT with L-SA, P=0.04). NPT did not affect FEV1 also in 51 ASA-tolerant asthmatics (89.7% pred.+/-6.9 in bsln, 86.6% pred.+/-4.3 after NPT), but in these subjects also Vol (from 14.9 cm3+/-4.2sd to 14.6 cm3+/-3.8SD), Req (0.38 cmH2O/l/min+/-0.14 in bsln, 0.26 cmH2O/l/min+/-0.2 after NPT, P=ns), and urinary LTE4 (333.1 pg/mg+/-202.8 in bsln, 318.0 pg/mg+/-198.7 after NPT, P=ns) remained unchanged. Only pre-NPT LTE4 values proved related to pre-NPT Req and Vol values (r=0.54 and r=-0.71, respectively), but not to patients' age (R=-0.05), and basal FEV1 (r=0.01).. In ASA-intolerant patients, NPT with lysine-aspirin (L-ASA) only induces a substantial nasal obstruction and enhances urinary LTE4 excretion in the absence of any significant bronchial obstruction. Nasal ASA challenge proves a test absolutely safe for asthma patients suspected of ASA intolerance. Measures of urinary LTE4 excretion contributed significantly to magnify the discriminant and the diagnostic value of NPT.

Topics: Administration, Intranasal; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Female; Forced Expiratory Volume; Humans; Leukotriene E4; Male; Middle Aged; Nasal Cavity; Nasal Provocation Tests; Nose; Rhinometry, Acoustic

The aims of the current study were to ascertain the prevalence of asthma and allergic rhinoconjunctivitis symptoms in Cairo, Egypt (northern Africa), and to elucidate the socioeconomic factors associated with symptom prevalence and severity. A translated and adapted version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to a sample of 2,645 11-15-yr-olds in state and fee-paying schools in Cairo. The overall prevalences of wheeze ever, wheeze during the last year and physician-diagnosed asthma were 26.5% (697 out of 2,631), 14.7% (379 out of 2,570) and 9.4% (246 out of 2,609), respectively. The prevalence of rhinoconjunctivitis was 15.3% (399 out of 2,616). Asthma symptoms were independently associated with attendance at a state school, parental asthma, age, history of rhinitis and owning a pet cat. Rhinoconjunctivitis was independently associated with attendance at a state school, father's education, parental history of asthma, asthma symptoms and owning a pet cat. In spite of a higher prevalence of severe asthma symptoms in state schools prevalence of physician diagnosis of asthma was the same in both school types, suggesting inequalities in access to healthcare. In conclusion, the prevalence of physician-diagnosed asthma in Cairo was 9.4%, while the prevalence of rhinoconjunctivitis was 15.3%. There is a higher prevalence and increased severity of asthma symptoms in children of lower socioeconomic groups, as defined by state school attendance in Cairo.

Topics: Adolescent; Asthma; Child; Egypt; Eye; Humans; Lung; Nose; Prevalence; Respiratory Sounds; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Socioeconomic Factors

To evaluate the clinical outcome and changes in allergen-specific antibodies during sublingual immunotherapy (SLIT) in house dust mite (HDM)-allergic asthma patients and to compare levels of allergen-specific antibodies in HDM-allergic patients before and after treatment with that of healthy controls.. Thirty-one asthma patients allergic to HDM were studied. Patients in groups I (n=17) and II (n=14) received SLIT with a standardized Dermatophagoides pteronyssinus plus Dermatophagoides farinae 50/50 extract for 6 and 12 months, respectively. A group of healthy children (n=8) were enrolled as controls. Patients in both groups were evaluated at the start and at the end of treatment according to daily symptom and medication scores, lung function and skin prick tests, PC20, blood eosinophil count, and Der-p-1-specific IgE, IgA, IgG1 and IgG4 levels.. Drug consumption decreased significantly in both groups. Furthermore, PC20 and forced expiratory flow between 25 and 75% of vital capacity of patients in group II improved significantly. Although specific IgA, IgG1 and IgG4 levels did not change throughout the treatment period, total eosinophil count and specific IgE decreased significantly in both groups. According to baseline measurements, specific IgA levels of patients in groups I and II were significantly lower than that of controls. This difference disappeared at the end of the treatment period in both groups.. SLIT seems to be effective in ameliorating clinical symptoms, drug consumption and bronchial hyperreactivity, and results in downregulation of Der-p-1-specific IgE production. Furthermore, at the end of SLIT, specific IgA levels, which were decreased compared to healthy controls initially, did no longer differ between patients and controls.

Topics: Administration, Sublingual; Asthma; Bronchial Provocation Tests; Budesonide; Case-Control Studies; Child; Eosinophils; Humans; Hypersensitivity; Immunoglobulins; Immunotherapy; Nose; Pulmonary Ventilation; Pyroglyphidae; Rhinitis; Skin Tests; Turkey

Persistent infection with Mycoplasma pneumoniae and Chlamydophila pneumoniae has been implicated in the progression or induction of asthma and chronic obstructive pulmonary disease. Evidence for this hypothesis has been obtained in adults either by serological methods or by direct pathogen detection using invasive procedures.. We investigated nasal brush specimens and induced sputum from 38 children with stable chronic lung disease (asthma, n = 26; chronic bronchitis n = 12) and from 42 healthy controls for the presence of M pneumoniae or C. pneumoniae DNA by polymerase chain reaction (PCR) using nested primers.. None of the controls but 23.6% and 10.5% of the children with lung disease had positive PCR for C pneumoniae (p = 0.001) and M pneumoniae (p = 0.044) respectively. Significantly more children with non-atopic asthma than with atopic asthma were positive for C pneumoniae or M pneumoniae (4/8 v 1/18; p = 0.018). There were no unwanted side effects from sputum induction. No correlation was found between detection of Chlamydophila and severity of lung disease. Colonisation with both organisms had occurred before adulthood in a significant proportion of children with stable chronic lung diseases.. Combining nasal brush specimens with induced sputum may be a useful non-invasive method for studying the role of C pneumoniae and M pneumoniae infection in children with different chronic lung diseases.

Topics: Adolescent; Asthma; Bronchitis, Chronic; Case-Control Studies; Child; Chlamydophila Infections; Chlamydophila pneumoniae; DNA, Bacterial; Humans; Mycoplasma pneumoniae; Nose; Pneumonia, Mycoplasma; Polymerase Chain Reaction; Prospective Studies; Sputum

Subjects with asthma frequently have nasal symptoms and complain of orthopnoea but airflow resistance is usually only assessed during oral breathing and while seated.. We have used a forced oscillation technique to measure total respiratory resistance (Rrs) at 6Hz during mouth breathing (Rrs,mo) and during nose breathing (Rrs,na) in the sitting and supine postures; resistance of the nasal airway (Rnaw) was estimated as Rrs,na--Rrs,mo. Forced oscillations were applied during normal tidal breathing and the mid-tidal lung volume (MTLV) was determined for each breathing route and posture.. Three groups of subjects were studied: 10 normal subjects without lung or nasal disease (N; five males, mean age 33.5 [range 23-58] years, mean FEV1 105%pred, FEV1/VC 86%); seven subjects with asthma alone (A; four males, 40.3 [23-57] years, mean FEV1 66%pred, FEV1/VC 74%); 10 asthmatic subjects with nasal obstructive symptoms (AN; six males, 62.8 [38-80] years, mean FEV1 56%pred, FEV1/VC 75%).. In all three groups of subjects, mean Rrs,mo and Rrs,na were higher in the supine than sitting posture. In normal subjects the increase in supine Rrs,mo was associated with a 0.6 liter fall in MTLV. In asthma supine Rrs,mo increased despite a much smaller fall in MTLV; supine increases in Rrs,na were particularly large in presence of nasal disease.. Values of airflow resistance are 2-3 times higher in both normal and asthmatic subjects when breathing via the nose and supine than under normal laboratory conditions of oral breathing and seated.

Topics: Adult; Airway Resistance; Asthma; Case-Control Studies; Female; Humans; Male; Middle Aged; Mouth; Nose; Pilot Projects; Posture; Reference Values; Respiration; Respiratory Mechanics; Sensitivity and Specificity

Allergic rhinitis and asthma are frequently associated and are characterized by TH2-dependent inflammation. Nasal and bronchial obstruction largely depend on allergic inflammation.. To evaluate the relationships among nasal eosinophil counts, interleukin 4 (IL-4) and interferon-gamma (IFN-gamma) levels, nasal airflow, and forced expiratory volume in 1 second (FEV1) in patients with perennial allergic rhinitis and asthma.. Eight men and 7 women (mean +/- SD age, 24.8 +/- 4.7 years) with perennial allergic rhinitis and asthma were evaluated. All 15 patients had a moderate-to-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, and spirometry were evaluated in all patients. Eosinophils were counted using conventional staining; IL-4 and IFN-gamma levels were measured by immunoassay in fluids recovered from nasal lavage.. Significant positive relationships were demonstrated between eosinophil infiltration and IL-4 levels, nasal airflow and IFN-gamma levels, FEV1 and IFN-gamma levels, and nasal airflow and FEV1 (P < .001 for all). Significant negative relationships were demonstrated between eosinophil infiltration and IFN-gamma levels, IL-4 and IFN-gamma levels, eosinophil infiltration and nasal airflow, IL-4 values and nasal airflow, nasal eosinophil counts and FEV1, and IL-4 values and FEV1 (P < .001 for all).. There is a close association between TH2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships among eosinophil infiltration, IL-4 and IFN-gamma levels, and nasal airflow. Nasal eosinophil, IL-4, and IFN-gamma levels correlate with FEV1. Finally, nasal airflow is related to FEV1. These findings constitute the first evidence of a relationship between TH2-related nasal inflammation and nasal and bronchial airflow in patients with perennial allergic rhinitis and asthma.

Topics: Adult; Asthma; Cytokines; Eosinophilia; Female; Forced Expiratory Volume; Humans; Inflammation; Male; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial

It remains to be established which factors contribute to the occurrence of asthma in allergic individuals. We hypothesized that differences in the late allergic inflammatory reaction to allergen between asthmatic and non-asthmatic house dust mite-allergic individuals might contribute to the difference in the clinical presentation of allergy.. To compare allergen-induced changes in parameters for cellular inflammation during the phase of the late allergic reaction in the skin and nose, in house dust mite-allergic individuals with or without asthma.. Nasal and dermal allergen challenges with house dust mite (Dermatophagoides pteronyssinus) extract were performed in 52 house dust mite-allergic individuals, of whom 26 had mild to moderate persistent asthma and 26 had perennial rhinitis without current or past asthmatic symptoms. Serial nasal lavage samples were analyzed for the presence of inflammatory cells (eosinophils and neutrophils) and soluble markers associated with cellular inflammation [interleukin-5 (IL-5), interleukin-8 (IL-8), eosinophil cationic protein (ECP) and myeloperoxidase (MPO)]. Macroscopic late phase skin reactions were studied after intracutaneous skin tests with house dust mite extract.. Fixed dose nasal allergen provocation elicited a similar degree of immediate allergic reaction as judged by plasma protein exudation and histamine concentrations in asthma and non-asthmatic rhinitis. Subsequently, no differences between groups were found during the phase of the late allergic reaction (4-24 h) in inflammatory cell influx, plasma protein leakage, ECP or MPO. Likewise, there were no differences in levels of chemotactic cytokines IL-5 and IL-8. In agreement with the results of nasal challenge, the late skin reaction after dermal challenge with a fixed allergen dose and after an allergen dose 10,000 times above the skin threshold for an early skin reaction did not differ between the groups.. House dust mite-allergic patients with or without asthma have very similar late allergic inflammatory reactions in the skin and in the nose after allergen challenge. Hence, it is unlikely that the occurrence of pulmonary symptoms in asthma is explained by a general tendency of asthmatics to have an enhanced late allergic cellular inflammatory response. Nasal and dermal allergen provocations are adequate models to study allergen-induced inflammation but probably lack the pivotal link which is essential for the development of asthma.

Topics: Adolescent; Adult; Allergens; Animals; Asthma; Biomarkers; Female; Humans; Inflammation; Male; Nasal Lavage Fluid; Nose; Pyroglyphidae; Rhinitis, Allergic, Perennial; Skin

Rhinosinusitis represents one of the most common chronic diseases. The association of rhinosinusitis with asthma has been frequently reported. Eosinophils and Th2 cells play a pathogenic mechanism in asthma.. The aims of the study were to evaluate the cytokine pattern in chronic rhinosinusitis in asthmatic children and to compare the findings in allergic vs. non-allergic asthmatics.. Thirty-five asthmatic children were evaluated, 19 males and 16 females, with an average age of 8.7 years. All children were asthmatic and suffered from chronic rhinosinusitis. Twenty were allergic and 15 were non-allergic. Ten healthy children were studied as normal controls. Evaluated parameters were the levels of the following cytokines: IL-1beta, IL-4, IL-6, IL-8, IL-12, IFN-gamma and TNF-alpha. Cytokines were recovered from rhinosinusal lavage and measured by immunoassays. Nasal cytology was also performed in all subjects and inflammatory cells were counted by conventional staining.. Allergic subjects showed a significant increase of IL-4 (P < 0.01) and TNF-alpha (P < 0.05) and a significant decrease of IL-12 (P < 0.05) and of IFN-gamma (P < 0.0001), whereas IL-1beta, IL-6 and IL-8 were not significantly increased. Non-allergic children showed a significant increase of IL-4 (P < 0.05) and a significant decrease of IFN-gamma (P < 0.0001), IL-12 was not significantly decreased, and IL-1beta, IL-6 and IL-8 were not significantly increased. A significant inflammatory infiltrate was present in all asthmatic children. Significant correlations were demonstrated between IL-4 and IL-12 (P < 0.001), IL-12 and IFN-gamma (P < 0.001), IL-8 and neutrophils (P < 0.01), and TNF-alpha and monocytes/macrophages (P < 0.05), in allergic asthmatics. IL-4 and IL-12 were significantly correlated (P < 0.05) as well as IL-8 and neutrophils (P < 0.01) in non-allergic asthmatics.. This study shows that allergic asthmatic children with chronic rhinosinusitis have a typical Th2 cytokine pattern, but also non-allergic asthmatic children share a similar pattern. These findings would suggest the existence of a common pathophysiological mechanism shared by upper and lower airways and are consistent with the concept of united airways disease.

Topics: Asthma; Child; Child Welfare; Child, Preschool; Chronic Disease; Cytokines; Female; Forced Expiratory Volume; Humans; Male; Nose; Phagocytes; Rhinitis; Severity of Illness Index; Sinusitis; Statistics as Topic

Upper respiratory airway diseases may induce a worsening of asthma. Sinusitis represents one of the most common chronic diseases. The association of asthma and sinusitis varies greatly in different studies, depending on diagnostic procedures.. The aims were: (i) to demonstrate that nasal endoscopy may be easily feasible in asthma at paediatric age; (ii) to evaluate the incidence of rhinosinusitis and adenoiditis in children with asthma by nasal endoscopy; (iii) to correlate inflammatory parameters such as cytology and microbiological cultures with nasal endoscopy findings.. One hundred and forty-five asthmatic children were evaluated, 48 males and 97 females, with an average age of 7.27 years. Evaluated parameters were the incidence of rhinosinusal infections in asthmatic children, and the role of: (i) nasal endoscopy, (ii) nasal cytology, and (iii) nasal microbiology in their diagnoses.. Nasal endoscopy was successfully performed on 128 patients. Twenty-six children had endoscopic rhinosinusitis alone, 10 had adenoiditis alone, and 35 showed endoscopic rhinosinusitis associated with adenoiditis. There were significant correlations between endoscopic rhinosinusitis and adenoiditis (P < 0.001), between clinical and endoscopic rhinosinusitis (P < 0.001), between endoscopic rhinosinusitis and adenoiditis and microbiology (P < 0.05 and P < 0.0001, respectively), and between microbiology and cytology (P < 0.05).. This study shows that rhinosinusal infections are common in asthmatic children. Moreover, nasal endoscopy might represent a fruitful tool in the management of asthmatic children.

Topics: Adenoids; Adolescent; Asthma; Child; Child Welfare; Child, Preschool; Endoscopy; Female; Humans; Incidence; Inflammation; Male; Nose; Odds Ratio; Rhinitis; Sinusitis; Statistics as Topic

To test the hypothesis that rhinovirus (RV)-induced immune responses influence the outcome of RV infections, we inoculated 22 subjects with allergic rhinitis or asthma with RV16. Nasal secretions and induced sputum were repeatedly sampled over the next 14 d. RV16 infection increased nasal granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-8, which was accompanied by neutrophilia in blood and nasal secretions. Nasal G-CSF correlated closely with increased blood neutrophils (r(s) = 0.69, p < 0.005), whereas nasal neutrophils correlated with both G-CSF (r(s) = 0.87, p < 0.001) and IL-8 (r(s) = 0.75, p < 0.001). Although similar relationships were present in sputum, changes in sputum neutrophils and G-CSF with RV16 infection were relatively modest. In addition, virus-induced changes in the sputum interferon-gamma-to-IL-5 messenger RNA ratio were inversely related to both peak cold symptoms (r(s) = -0.60, p < 0.005) and the time to viral clearance (undetectable picornavirus RNA). These results indicate that airway IL-8 and G-CSF are closely associated with virus-induced neutrophilic inflammation during an experimental RV infection in atopic volunteers. In addition, the balance of airway T-helper cell type 1 (Th1)- and Th2-like cytokines induced by RV infection may help determine the clinical outcome of common cold infections, raising the possibility that the individual subject's immune response, rather than atopic status per se, is important in this regard.

Topics: Adolescent; Adult; Asthma; Base Sequence; Bronchi; Common Cold; Cytokines; Female; Humans; Male; Molecular Sequence Data; Nasal Lavage Fluid; Nose; Patient Selection; Reverse Transcriptase Polymerase Chain Reaction; Rhinitis, Allergic, Perennial; Rhinovirus; Sputum; Time Factors

We developed a sensitive polymerase chain reaction (PCR) panel, suitable for the detection of seven common respiratory viruses, to study the prevalence of viruses in nasal swabs obtained from clinically stable asthmatic children (n = 21), non-physician diagnosed asthmatic children with exercise-induced bronchoconstriction (EIB) (n = 16), and nonasthmatic, non-EIB controls (n = 33). The PCR panel detected viruses in 43/70 (61.4%) specimens but there were no significant differences in prevalence of these viruses between the three groups of children. These results indicate that clinically stable asthmatic and nonasthmatic children frequently harbor viruses in the upper respiratory tract.

Topics: Adenoviruses, Human; Asthma; Child; Coronavirus; DNA, Viral; Female; Humans; Influenza A virus; Male; Nose; Picornaviridae; Polymerase Chain Reaction; Respiratory Syncytial Virus, Human; Respirovirus; RNA, Viral; Sensitivity and Specificity; Viruses

Topics: Adult; Asthma; Female; Forced Expiratory Volume; Humans; Lung; Male; Middle Aged; Nose; Temperature

To measure route of breathing in chronic asthmatic patients during and after an acute severe exacerbation.. Thirteen asthmatic patients were studied during hospital admission for acute asthma and, in 9 patients, again when asymptomatic. Nine healthy subjects were also studied.. Spontaneous route of breathing was qualitatively assessed using oral and nasal thermistor probes, and was then quantified using a dual compartment face mask with attached pneumotachographs.. All asthmatic patients had severe bronchoconstriction initially (FEV(1), 46 +/- 3% of predicted) that had resolved at follow-up (FEV(1), 91 +/- 6% of predicted). No healthy subject had evidence of bronchoconstriction (FEV(1), 102 +/- 5% of predicted). During acute asthma, 11 asthmatics were spontaneously breathing oronasally, as assessed using thermistor probes, while all 13 breathed oronasally via face mask. When assessed using thermistor probes, seven of nine asymptomatic asthmatic patients studied were breathing exclusively via the nose; however, all breathed oronasally via face mask. In contrast, while eight of nine healthy subjects were also breathing exclusively via the nose when assessed using thermistor probes, all breathed nasally only via face mask.. Thus, when asymptomatic and at rest, asthmatic patients breathe exclusively via the nose. However, during acute exacerbations of asthma, these patients switch to oronasal breathing. Unlike healthy subjects, chronic asthmatic patients also switch to oronasal breathing when wearing a face mask, irrespective of the degree of bronchoconstriction. We speculate that asthmatics may have an increased tendency to switch to oral breathing, a factor that may contribute to the pathogenesis of their asthma.

Topics: Adult; Asthma; Bronchoconstriction; Chronic Disease; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Mouth; Nose; Respiration

In atopic subjects with multiple sensitizations to inhalant allergens the relationship between the specific serum immunoglobulin (Ig) E and the in vivo response to each allergen is not well established.. To investigate the relationship between the specific serum IgE expressed as amount (kU/L) or density (specific IgE/total IgE percentage) with the in vivo response to inhaled allergens in rhinitic and asthmatic subjects with multiple sensitization.. By means of Reverse Enzyme AllergoSorbent Test (REAST) the absolute values and the density of specific IgE for each sensitizing allergen was determined. Rhinitics (n = 12) underwent nasal and asthmatics (n = 11) bronchial allergen challenges with the two to three sensitizing allergens for a total of 33 nasal and 32 bronchial challenges. Correlations and degree of concordance between specific serum IgE and results of challenges were calculated.. IgE density significantly correlated with nasal challenge score (rs = 0.72, P < 0.001), bronchial challenge score (rs = 0.56, P < 0.001) and late asthmatic response (rp = 0.53, P < 0.005). Among subjects with three sensitizations, comparison of values of IgE density with the results of challenges showed significant concordance in graduation (chi2 = 11.3, P < 0.005).. In subjects with multiple sensitizations, the nasal and bronchial response to the different sensitizing allergens may be predicted, at least in part, by the IgE density. A satisfactory agreement between graduation of the IgE density to the different allergens and the in vivo response to the same allergens has been found within subject.

Topics: Administration, Inhalation; Adolescent; Adult; Allergens; Asthma; Bronchi; Bronchial Provocation Tests; Female; Humans; Immunoglobulin E; Male; Methacholine Chloride; Middle Aged; Nose; Predictive Value of Tests; Radioallergosorbent Test; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Our aim was to study the concentration of nitric oxide in the exhaled (ENO) and nasal (NNO) air of normal children and asthmatic children who are clinically and functionally stable.. Using a nitric oxide chemiluminescence analyze and a register for CO2, pressure and flow, we studied 73 schoolchildren (6-17 years of age). This included 37 controls and 36 asthmatic children, 21 with mild asthma without antiinflammatory treatment and 15 treated with inhaled corticosteroids. We used the technique of slow exhalation against resistance for (ENO) determination and aspiration with stable flow in nasal cavity while holding the breath for (NNO) determination.. The mean ENO was 3.1 ppb (1-6) in the control group, 8.3 ppb (1.7-29.3) in the mild asthma group and 7.7 ppb (2-18.3) in the asthmatics treated with corticosteroids. There were significant differences (p = 0.0001) between the controls and both asthmatic groups. The mean NNO in the controls was 898 ppb and differences between this group and the asthmatic children were found. The ENO and NNO did not change in relation to age or sex. We did not find any relationship between ENO and lung function. There is a significant correlation between ENO and NNO in both asthmatic groups, but not in the control group.. The ENO was higher in asthmatics than in control children. The slow exhalation against resistance technique prevents the contamination of exhaled air with nasal air and this technique can be applied to children over 6 years of age. The NNO was similar in the asthmatic groups and the control group.

Topics: Analysis of Variance; Asthma; Breath Tests; Child; Female; Humans; Linear Models; Luminescent Measurements; Male; Nitric Oxide; Nose; Reference Values

The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. The aim of the study was to assess the relation between objective indices of nasal patency, as assessed by the occlusion method (RN) and the Youlten peak nasal inspiratory flow meter (PNIF), with subjective sensations of nasal blockade by either the patient or the clinician in groups of patients with rhinitis, asthma, rhinitis and asthma, nasal septal deformity and ill normal controls. We studied nasal airway patency in 254 subjects (37 women, 217 men), mean age 21 years (range 14-78) by RN and PNIF. Nasal resistance was also measured by the application of Ohm's law for parallel resistors (NRO) by estimating the unilateral resistance separately. Subjective sensation of nasal blockade was assessed either by the patient on a 10-point Borg scale (SUB), or the clinician (CLN) on a 6-point scale (3 for each side of the nose). The latter was done in a controlled fashion with the aid of reference sensations. Adjusting for age, height, smoking status and airway calibre, we found good correlation between RN and CLN (r=0.57, p=10(-4)), whereas the association between RN and SUB was moderate and of borderline significance (r=0.42. p=0.05). By logistic regression analysis, we found that the only independent predictors of abnormal nasal resistance at a cut-off value of 0.30 kPa/l/s were the nasal scores as assessed by the clinician (r-=0.26, odds=2.45). We conclude that PNIF measurement and SUB scores are of limited use as indices of nasal patency, although the latter showed an improved association in comparison to older studies. As there is a necessity for some sort of objective measurement to assess nasal patency, the described clinician evaluation may be clinically useful in place of PNIF, but due to its somewhat subjective nature and its inability to detect milder levels of nasal obstruction it cannot be recommended as an alternative to rhinomanometry.

Topics: Adolescent; Adult; Age Factors; Aged; Airway Resistance; Analysis of Variance; Asthma; Body Height; Cohort Studies; Cross-Sectional Studies; Female; Humans; Inhalation; Logistic Models; Male; Manometry; Middle Aged; Nasal Obstruction; Nasal Septum; Nose; Prospective Studies; Pulmonary Ventilation; Rheology; Rhinitis; Sensitivity and Specificity; Smoking

The nose and not the mouth should be used for breathing as the nose has better air conditioning capacity. When air is inhaled through the mouth it may dry and cool the respiratory mucosa, which can lead to bronchoconstriction in sensitive patients with asthma. By dilating the nostrils you can increase nasal breathing in most subjects. The aim of this study was to investigate whether sleeping with dilated nostrils reduces nocturnal asthma. At the Asthma and Allergy Research Centre, Gothenburg, 15 out-patients with nocturnal asthma were selected. Every other night for 10 nights the test subjects slept with the nasal dilator Nozovent which has been shown to increase the nasal air-flow and decrease the need for mouthbreathing. Every morning the patients self-reported on a form whether they had woken with asthma during the night or if they had had to take asthma medication. When sleeping with the nasal dilator the patients woke up with asthma on 17 of 75 nights as compared with 32 of 75 when sleeping without the device (p < 0.01). Reduced nocturnal asthma was observed by 12 patients and less need for asthma medication at night by 7. None of the patients noted any side-effects due to the device. In conclusion, the easy-to-use and cheap medical device, Nozovent, which mechanically dilates the nostrils and improves nasal breathing, can reduce nocturnal asthma.

Topics: Adult; Aged; Asthma; Breathing Exercises; Dilatation; Female; Humans; Male; Middle Aged; Nose; Posture; Pulmonary Ventilation

Our study was to assess whether there were differential effects of nasal continuous positive airway pressure (nCPAP) on different kinds of obstruction in either upper or lower airways in patients with chronic obstructive pulmonary disease (COPD). nCPAP (6 cmH2O for ten minutes) was applied to 7 patients with reversible extrathoracic upper airway obstruction (RUAO) and 3 patients with fixed extrathoracic upper airway obstruction (FUAO). Eighteen stable asthmatics, receiving methacholine challenge to induce a more than 20% reduction in FEV1, were randomly investigated for the effect of nCPAP or sham pressure on reversible lower airway obstruction. Nine stable COPD patients were enrolled to study the effect on irreversible lower airway obstruction. Maximal expiratory and inspiratory flow volume curves and dyspnoea scores were obtained before and after immediate withdrawal of nCPAP. In the RUAO group, nCPAP significantly improved stridor and dyspnoea scores, decreased the ratio of FEF50/FIF50 from 2.05 +/- 0.25 to 1.42 +/- 0.16, and increased peak inspiratory flow (PIF) as well as forced inspiratory vital capacity by 26 +/- 8% and 9 +/- 4%, respectively. In expiratory phase, there was no significant change in pulmonary functions. In asthmatics, nCPAP significantly reversed methacholine-induced bronchoconstriction increasing forced vital capacity by 10 +/- 3%, FEV1 by 15 +/- 4% and PIF by 32 +/- 11%. nCPAP significantly increased the response to bronchodilators. The improvement in airflow rate persisted for at least 5 min after nCPAP withdrawal and was highly correlated with the response to bronchodilators. There was no significant effect of nCPAP on airflow rate in COPD patients. Subjective dyspnoea score changes paralleled the pulmonary function improvement. We conclude that there are differential effects of nCPAP on airflow rates in patients with different nature of airway obstruction. Patients with airway obstruction caused by structural changes may not benefit from the use of nCPAP in improving airflow rates.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Asthma; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nasal Obstruction; Nose; Positive-Pressure Respiration; Respiratory Function Tests; Treatment Outcome

The aim of our study was to investigate the prevalence of surgery on the nose prior to first time diagnosis of nasal polyps. We interviewed 60 patients who presented to the ENT Department at the Royal South Hants Hospital Southampton and were diagnosed as suffering from nasal polyps for the first time. Patients who suffered from cystic fibrosis or known primary ciliary dyskinesia were excluded. The average length of time of nasal blockage as the main symptom prior to the diagnosis of nasal polyps was less than two years. Out of the 60 patients six (10 per cent) had had previous nasal surgery. Out of these six patients, only four patients had a previous procedure on the nose that could be considered to be related to the later diagnosis of nasal polyps. Only one patient had had radiological investigation of his sinuses in the past. We conclude that polypoid nasal disease is a de novo diagnosis with a relatively short history in the majority of patients and not preceded by a long history of ENT investigations nor surgery on the nose.

Topics: Adult; Aged; Aged, 80 and over; Asthma; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nose

Nitric oxide (NO) is present in exhaled air of humans. This NO is mostly produced in the upper airways, whereas basal NO excretion in the lower airways is low. Children with Kartagener's syndrome have an almost total lack of NO in nasally derived air, whereas adult asthmatics have increased NO in orally exhaled air. NO excretion was measured in the nasal cavity and in orally exhaled air in 19 healthy children, in 36 age matched subjects with asthma, and in eight children with cystic fibrosis. NO levels in orally exhaled air were similar in controls and in children with cystic fibrosis, at 4.8 (SD 1.2) v 5.8 (0.8) parts per billion (ppb), but were increased in asthmatic children who were untreated or were being treated only with low doses of inhaled steroids (13.8 (2.5) ppb). Nasal NO levels were reduced by about 70% in children with cystic fibrosis compared to controls and asthmatics. Measurements of airway NO release in different parts of the airways may be useful in non-invasive diagnosis and monitoring of inflammatory airway diseases.

Topics: Adolescent; Adult; Anti-Inflammatory Agents; Asthma; Breath Tests; Budesonide; Child; Child, Preschool; Cystic Fibrosis; Drug Administration Schedule; Humans; Kartagener Syndrome; Nitric Oxide; Nose; Pregnenediones

Chronic sinusitis, in contrast to acute sinusitis, often presents with nonspecific symptoms that may be confused with other disease entities. Due to the cost of computerized tomography and the difficulty in interpreting sinus radiographs in certain children, a search for a simpler screening tool for chronic sinusitis in children was undertaken.. This study was undertaken to provide a quantitative comparison between the methods of wax paper blow and Rhinoprobe scraping for nasal cytology in screening for chronic sinusitis while minimizing selection bias.. Twenty serially selected patients (13 males and seven females) with a mean age of 11 years (range 6-16) were enrolled. Nasal cytology was obtained via two methods: scraping of the turbinate with a Rhinoprobe (Synbiotics Inc.,) and wax paper blow.. The results showed that > or = 5 neutrophils per high power field on Rhinoprobe cytology significantly correlated with radiographic sinusitis (P < .05 by Chi-square and P < .056 by Fisher's exact test). The sensitivity and specificity for > or = 5 neutrophils per high power field were 100% and 53%, respectively. Counts of other nasal cells, such as eosinophils, bacteria, and epithelial cells, did not yield significant correlations with radiographic sinusitis.. We feel that the Rhinoprobe, with criteria of > or = 5 neutrophils per high power field, may be useful as a screen for occult chronic sinusitis in childhood asthma. Confirmation of sinusitis via X-ray is still necessary if neutrophils are present on Rhinoprobe nasal cytology.

Topics: Adolescent; Asthma; Child; Chronic Disease; Female; Humans; Leukocyte Count; Male; Nasal Mucosa; Neutrophils; Nose; Sensitivity and Specificity; Sinusitis; Tomography, X-Ray Computed

Although the nose and the bronchi are both involved in the process of regulating respiratory heat exchange, thermal changes may precipitate airway obstruction during exercise but rarely cause nasal obstruction in patients with rhinitis. The cause of the different response of the nose and bronchial tree has hardly been investigated. This study was performed to assess the response of the nose during exercise in the presence of rhinitis, asthma, and in normal controls.. Ten healthy subjects (group 1), 15 patients with asthma and rhinitis (group 2), 10 with rhinitis only (group 3), and 11 with asthma only (group 4) were included in the study. Exercise was performed on a bicycle ergometer for six minutes, reaching a heart rate of 80% of predicted. Bronchial and nasal responses were measured by forced expiratory volume in one second (FEV1) and posterior rhinomanometry, respectively. A drop in the FEV1 of 20% or more was considered a positive exercise induced asthma challenge test.. Heart rate and ventilation increased by a similar proportion in the four groups. The FEV1 significantly decreased in asthmatic patients (groups 2 and 4) but it did not change in healthy subjects (group 1) or in those with rhinitis (group 3). Thirteen asthmatic patients developed exercise induced asthma. Nasal patency increased with exercise by a similar proportion in all groups, and no differences were detected between those with rhinitis (groups 2 and 3) and those without (groups 1 and 4). Nasal patency had returned to basal values at 25 minutes after completion of exercise in the four groups. The nose of patients with exercise induced asthma, however, remained significantly more patent than in patients without exercise induced asthma between 10 and 30 minutes after exercise.. These results suggest that the nose responds differently from the bronchi during exercise induced airway obstruction: whereas the bronchial tree responds by becoming narrowed, the nose becomes more patent. These findings suggest that the mechanisms regulating the response of the nose to exercise are different from those involved in the response of the bronchial tree.

Topics: Adult; Asthma; Bronchi; Exercise; Exercise Test; Female; Forced Expiratory Volume; Heart Rate; Humans; Male; Manometry; Nose; Rhinitis

1. Reflex bronchial changes have been demonstrated after nasal stimulation in both man and experimental animals. The existence of a pulmonary-nasal reflex is less established. We have examined whether induced narrowing of the intrathoracic airways leads to increases in nasal airflow resistance (Rnaw) in patients with asthma. 2. We have used a non-invasive forced oscillation method to measure total respiratory resistance (Rrs) at 8 Hz during tidal breathing sequentially via the nose (Rrs, na) and via the mouth (Rrs, mo) and derived Rnaw by subtracting Rrs, mo from Rrs, na. We examined whether changes in Rnaw occurred when increases in Rrs, mo were induced by inhaling histamine aerosol via the mouth with the nose occluded in 11 patients with stable, mild asthma (six males, age 28.1 +/- 2.1 years, forced expiratory volume in 1 s 97 +/- 6% of predicted, means +/- SEM). Six of the patients had a history of rhinitis. The patients were first challenged with doubling concentrations of histamine via a dosimeter to establish the dose which reduced the forced expiratory volume in 1 s by > or = 20%. Two hours later when the forced expiratory volume in 1 s had returned to baseline, they were challenged with saline and again 2 h later with the concentration of histamine that had earlier caused a > or = 20% fall in the forced expiratory volume is 1 s. 3. Between 0.5 and 10 min after histamine inhalation, a sustained increase in Rrs, mo was achieved with mean increases averaging 68-77% above baseline over this period (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Airway Resistance; Asthma; Bronchoconstriction; Female; Forced Expiratory Volume; Histamine; Humans; Male; Middle Aged; Nose; Rhinitis

Topics: Asthma; Humans; Male; Nose; Respiration; Skiing

The prevalence of preferential nasal breathing was studied in an awake adult population. One hundred and ninety-four people consented to gentle manual compression of the nostrils. They were advised to 'breathe in and out', but no further information regarding breathing was given to avoid influencing the patient. One hundred and eighty patients (92.8%) commenced immediate regular relaxed breathing. Fourteen patients (7.2%) had difficulty with oral breathing which ranged from irregular mouth breathing associated with distress to no spontaneous respiration. The prevalence of preferential nasal breathing was strongly associated with increasing age (chi 2 for trend, P = 0.007). In addition, a weakly significant association was demonstrated between a history of asthma and this phenomenon (P = 0.047). These findings suggest a tendency for the elderly person to revert to the infant pattern of obligate nasal breathing. Physicians should be aware of this possibility in the elderly patient, especially prior to any procedure which may induce nasal obstruction.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Apnea; Asphyxia; Asthma; Female; Humans; Male; Middle Aged; Mouth; Mouth Breathing; Nasal Obstruction; Nose; Prevalence; Respiration

Sinusitis should be suspected in cases of chronic, difficult to control asthma or other pulmonary diseases. Appropriate measures to diagnose and treat sinus disease are listed, and an upright Waters roentgenogram may be all that is required for diagnosis. A true sino-bronchial reflex is proposed in these patients. Nasal receptors and reflexes are effective in the physiology of the nose, and in many cases, the diagnosis and treatment of rhinitis and sinusitis results in the improvement of various chronic pulmonary conditions.

Topics: Asthma; Bronchial Spasm; Cranial Nerves; Humans; Male; Middle Aged; Nose; Paranasal Sinuses; Pharynx; Receptors, Neurotransmitter; Sinusitis

Three adult patients with asthma with preferential nasal breathing were found to have a typical pattern of lung function test results with substantial between test variation. This condition can be identified as a cause of unsatisfactory performance in respiratory tests by observing the patient's reaction after the nostrils have been occluded.

Topics: Aged; Asthma; Female; Humans; Lung; Male; Middle Aged; Nose; Respiration; Respiratory Function Tests

We performed cytologic evaluations of 6116 nasal and/or bronchial smears from 4510 patients (average age: 7.6 years; 3 months--17 years) suffering from different kinds of chronic nonspecific respiratory diseases (CNSRD); in 137 children (average age: 4.8 years) undergoing bronchologic examinations under general anesthesia we compared the findings with those for bronchoalveolar lavage (BAL). Nasal smears of 77 healthy children at a day care center (control group) were analysed four times per year for "significant secretory eosinophilia" (SEE; i.e. more than 13% eosinophils). We found: 1. Healthy children do not have such "SSE" in contrast to children with CNSRD who show different frequencies of "SSE" depending on the age of the child and the specific kind (diagnosis) of CNSRD. 2. 4.6% of infants (first year of life) were found to have SSE with a statistically significant correlation to increase in the following 10 years up to 50% of all children (p less than 0.001). 3. We found SSE in 4.41% of cases with relapsing bronchitis, in 7.14% (8.3% resp.) with chronic bronchitis, in 6.49% (9.2% resp.) with relapsing or chronic obstructive bronchitis and in 46.05% (55.3% resp.) with bronchial asthma (p less than 0.001). 4. The intensity of obstructive symptoms (nose: rhinitis; bronchus: dyspnoea) did not correlate with the number of eosinophils in the secretions. 5. Only the smear cytograms (nose/bronchus) enabled us to detect "SSE" whereas BAL cytograms were too insensitive (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Asthma; Bronchi; Bronchitis; Bronchoalveolar Lavage Fluid; Child; Child, Preschool; Eosinophils; Exudates and Transudates; Humans; Infant; Lung Diseases, Obstructive; Nose

Topics: Animals; Asthma; Bronchi; Forced Expiratory Volume; Humans; Nose; Pollen; Reflex; Rhinitis, Allergic, Seasonal; Sinusitis

Release of high molecular weight-neutrophil chemotactic activity from human tissues, cells and secretion was studied in vivo and in vitro. Lung, nasal turbinate, nasal polyps, skin of neurofibromatosis, basophils from chronic myeloid leukemia and cultured basophilic cells from cord blood released this mediator following calcium ionophore, antigen, anti-IgE or homogenization in vitro. Its release was also demonstrated in human nasal secretions from patients with allergic rhinitis following antigen challenge. Regarding mononuclear cells no release of this mediator was observed from normal donors or asthmatic patients having no active attack upon challenge with calcium ionophore, phytohemagglutinin or antigen. Homogenized duodenum released high molecular weight-neutrophil chemotactic activity but less activity in comparison with other tissues or cells mentioned above.

Topics: Asthma; Basophils; Chemotactic Factors; Chemotaxis, Leukocyte; Duodenum; Humans; Leukocytes, Mononuclear; Lung; Nasal Polyps; Nasal Provocation Tests; Neurofibromatosis 1; Neutrophils; Nose; Rhinitis, Allergic, Perennial

Topics: Asthma; Asthma, Exercise-Induced; Bronchi; Humans; Nose

We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.

Topics: Adolescent; Adult; Asthma; Humans; Male; Middle Aged; Nose; Pharynx; Positive-Pressure Respiration; Prospective Studies; Sleep Apnea Syndromes; Snoring; Time Factors

More than 20% of the general population is afflicted with a common medical disorder--allergic rhinitis. Recent research in rhinitis has brought about much new information and created possibilities for new means and methods of diagnosis and treatment.

Topics: Airway Resistance; Asthma; Dermatitis, Atopic; Humans; Nasal Mucosa; Nose; Receptors, Adrenergic; Receptors, Histamine; Reflex; Rhinitis, Allergic, Seasonal; Risk; Skin Tests

We investigated the effect of aerosols inhaled into the lungs on nasal airflow resistance (Rnaw) using a constant inflow pressure method with measured airflow. Isotonic saline and water aerosols produced no immediate significant change in Rnaw and forced expired volume in 1 s (FEV1); however, water gradually decreased FEV1 and increased Rnaw, the response being maximal 10-15 min after provocation. Histamine aerosol significantly increased Rnaw in healthy subjects, asthmatics and asthmatics with allergic rhinitis. There was also a corresponding decrease in FEV1. The increase in Rnaw and the decrease in FEV1 were reversed by inhalation of terbutaline (10 mg . ml-1). Similarly, terbutaline in patients with mild asthmatic attacks decreased Rnaw and increased FEV1. Since terbutaline applied locally into the nose is known to increase Rnaw, we conclude that lung provocation can increase nasal Rnaw, presumably via nervous pathways.

Topics: Adolescent; Adult; Aerosols; Aged; Airway Resistance; Asthma; Bronchial Provocation Tests; Forced Expiratory Volume; Histamine; Humans; Isotonic Solutions; Middle Aged; Nose; Rhinitis, Allergic, Perennial; Sodium Chloride; Terbutaline; Water

Exercise-induced change of nasal resistance and forced expiratory volume in 1 second (FEV1.0) were studied in 30 asthmatic children and seven normal children. Exercise-induced asthma (EIA) was diagnosed in 19 (63%) of the 30 asthmatic patients. Unilateral complete nasal blockage after exercise (exercise-induced nasal obstruction [EINO]) was found in nine (30%) of the 30 asthmatic patients. A marked decrease in nasal resistance took place immediately or 4 minutes after exercise in all cases. EIA is most severe 5 minutes after exercise, and EINO took place 14 or 19 minutes after exercise. The seven normal children had neither EIA nor EINO. The pathophysiologic relationship between EIA and EINO is discussed.

Topics: Adolescent; Airway Resistance; Asthma; Asthma, Exercise-Induced; Child; Female; Forced Expiratory Volume; Humans; Male; Nose

Nasal mucociliary clearance was measured using a saccharin technique in 172 patients with perennial rhinitis (76 also had asthma) and in 121 patients with chronic infected rhinosinusitis (40 had asthma, 35 had bronchiectasis). All patient groups had significantly longer mean nasal mucociliary clearance times than that of a group of healthy subjects. Grossly prolonged clearance (greater than 60 minutes) occurred in significantly more patients with the clinical syndrome of chronic infected rhinosinusitis and bronchiectasis than in the syndromes of chronic infected rhinosinusitis with or without asthma, and perennial rhinitis with or without asthma. The abnormal clearance was shown not to be due to an intrinsic ciliary defect by in vitro examination of nasal cilia but probably to be due to a combination of mucus and ciliary factors in vivo.

Topics: Adolescent; Adult; Asthma; Bronchiectasis; Cilia; Female; Humans; Male; Middle Aged; Mucus; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Saccharin; Sinusitis

Topics: Asthma; History, 20th Century; Humans; Nose; Reflex

"Triad" asthmatics often have sinus disease, nasal polyps, and obstructive airways disease. This presentation is reminiscent of the symptoms of persons afflicted with various forms of ciliary dyskinesia. Therefore, we examined tissues from seven "triad" asthmatic patients for ciliary structural or functional abnormalities. Transmission and scanning electron microscopy revealed no specific abnormalities. Cultures of nasal epithelia were maintained for up to 20 weeks. They showed normal ciliary activity which was not influenced by perfusing the tissue with medium containing aspirin. In contrast, control tissue from a patient with situs inversus and sinusitis showed the expected structural and functional ciliary abnormalities. In culture, the ciliary function of tissue from this patient could be partly restored by perfusion with ATP or ATPase.

Topics: Adenosine Triphosphatases; Adenosine Triphosphate; Adolescent; Adult; Aspirin; Asthma; Cells, Cultured; Cilia; Drug Hypersensitivity; Epithelium; Female; Humans; Male; Microtubules; Nasal Polyps; Nose

In 27 asthmatic patients a single cold stimulus into the nose resulted in a sudden increase of airway resistance, measured continuously by a forced-oscillation technique. The effect could be blocked by previous intrabronchial application of an anticholinergic drug. In laryngectomised patients, who no longer have a connection between the upper and the lower airways, a cold stimulus into the nose also caused bronchoconstriction. So the cold effect must be based on a reflex mechanism.

Topics: Airway Resistance; Asthma; Bronchi; Cold Temperature; Humans; Nose; Respiratory Function Tests; Vagus Nerve

The effect of nasal as well as oral breathing during level-ground running for 6 min on the post exercise bronchial response was studied in fifteen people (five asthmatics with exercise liability, five asthmatics with no such liability and five normals). Each patient did the exercise twice; once with the nose clipped and once with the mouth closed. FEV1 was measured before exercise, immediately after exercise and at 5, 10, 15, 20 and 30 min thereafter. A fall in FEV1 of 20% or more from the basal level was taken as evidence of bronchoconstriction. When the patients were required to breath only through the nose during the exercise, the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral breathing during exercise, indicating a beneficial effect of nasal breathing. Nasal breathing was beneficial as compared with oral breathing in normals as well. In the five asthmatics with no exercise liability no appreciable difference was observed. This study suggests that the oropharynx and nasopharynx play important roles in the causation of exercise-induced asthma.

Topics: Adolescent; Adult; Asthma; Asthma, Exercise-Induced; Child; Female; Forced Expiratory Volume; Humans; Male; Mouth; Nose; Respiration

Forty-eight perennial rhinitis patients completed a six weeks' open trial of intranasal beclomethasone dipropionate aerosol. Each received a daily dose of 400 micrograms. Thirty-five responded excellently, seven reported satisfactory improvement and six failed. This study indicated that patients with a demonstrable allergic component responded favorably. However, due to the wide margin of safety the authors suggest that it be tried on the non-infective perennial rhinitis with no demonstrable allergic component as well.

Topics: Administration, Intranasal; Adolescent; Adult; Asthma; Beclomethasone; Eosinophils; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Mucosa; Nose; Radiography; Rhinitis, Allergic, Perennial; Skin Tests

Topics: Adolescent; Asthma; Child; Humans; Hypersensitivity; Manometry; Nose

In the first step of a study of the relation of nasal and oral breathing during moderate treadmill exercise to the onset of bronchoconstriction in young patients with perennial bronchial asthma, it was observed that most subjects spontaneously breathed with their mouths open when instructed to breathe "naturally." Subsequently, when they were required to breathe only through the nose during the exercise, an almost complete inhibition of the postexercise bronchoconstrictive airway response was demonstrated. When instructed to breathe only through the mouth during exercise, an increased bronchoconstrictive airway response occurred, as measured by spirometry, flow-volume relationships, and body plethysmography. These findings suggest that the nasopharynx and the oropharynx play important roles in the phenomenon of exercise-induced bronchoconstriction.

Topics: Adolescent; Asthma; Bronchial Spasm; Child; Female; Humans; Lung; Lung Volume Measurements; Male; Mouth Breathing; Nose; Physical Exertion

Serial nasal, intracutaneous, or bronchial challenges were carried out with solutions containing 2- or 3-fold increments in histamine (H) or methacholine (Meth) concentration until nasal airway resistance (NAR) increased by more than 100%, a large intracutaneous reaction was elicited, or FEV1 decreased by 20% or more. Thirty nonatopic and 48 asymptomatic atopic subjects were studied, the latter group divided into rhinitic patients with and without asthma. Several types of data analysis demonstrated there was no significant difference in the nasal or cutaneous effects of H or Meth between the atopic and nonatopic groups. Comparable results were obtained in a subgroup of 39 subjects (13 normal, 13 atopic, and 13 atopic with asthma) who underwent all six test sequences (i.e., nasal, cutaneous, and bronchial with both drugs). As expected, the asthmatics showed significantly increased bronchial reactivity to both agents. In comparison with Meth, H had a much greater effect on the nasal mucosa and skin than on the bronchi. It is concluded that, contrary to bronchial responses, but in accord with cutaneous reactivity, the nasal responses of nonatopic subjects, atopic persons with allergic rhinitis alone, and subjects with both allergic rhinitis and asthma show no intergroup differences on testing with H or Meth.

Topics: Airway Resistance; Asthma; Bronchi; Dose-Response Relationship, Drug; Histamine; Humans; Hypersensitivity; Methacholine Compounds; Nose; Skin Tests

Indications and results of 125 Vidian neurectomies done in 64 patients have been presented. The indications were grouped as: Rhinorrhoea (37.5%), Nasal Polyposis (3.12%); Headaches and Faceaches (45.32%); and Bronchial Asthma (14-06%). Four initial Vidian neurectomies were done unilaterally and produced only partial relief in symptoms. Bilateral Vidian neurectomy relieved completely all the rhinorrhoea cases, all the nasal polyposis cases, 79-3% of headache and faceache cases and 55-5% of bronchial asthma cases.

Topics: Asthma; Denervation; Headache; Humans; Nasal Polyps; Nose; Nose Diseases; Rhinitis

Topics: Adolescent; Asthma; Beclomethasone; Child; Child, Preschool; Drug Evaluation; Female; Humans; Male; Nose; Respiratory Therapy; Rhinitis, Allergic, Seasonal

The introduction of some new physical methods has considerably improved the writer's treatment of asthmatic children. These methods include an endeavour to attain nasal breathing, together with slow, deep "sleep breathing", and a system of eight or ten physiotherapy exercises which are described in detail. Since their adoption the consumption of aerosol bronchodilators has fallen dramatically.

Topics: Airway Obstruction; Asthma; Breathing Exercises; Child; Child, Preschool; Hospitalization; Humans; Metaproterenol; Nose; Physical Therapy Modalities; Private Practice; Sleep

Topics: Adolescent; Asthma; Beds; Child; Child, Preschool; Dust; Environment; Heating; Housing; Humans; Immune Sera; Immunodiffusion; Immunoglobulin E; Mites; Nose; Skin Tests

Topics: Acetone; Air Pollution; Asthma; Central Nervous System; Cough; Cyanates; Dermatitis, Occupational; Environmental Exposure; Eye; Headache; Hearing Disorders; Humans; Maximum Allowable Concentration; Mucous Membrane; Noise; Nose; Occupational Diseases; Paint; Petroleum; Pharynx; Plastics; Respiratory Function Tests; Toluene; Ventilation; Xylenes

Topics: Adult; Aged; Asthma; Autopsy; Bronchi; Child; Female; Frontal Sinus; Humans; Hypersensitivity; Lung; Male; Mucous Membrane; Nasal Mucosa; Nose; Paranasal Sinuses; Respiratory System

Topics: Adult; Asthma; Epistaxis; Female; Finland; Headache; Heart Diseases; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Diseases; Posture; Pressure; Respiration; Rhinitis; Rhinitis, Allergic, Seasonal; Sleep; Smell; Smoking; Sneezing; Spirometry

Topics: Asthma; Cartilage; Child; Child, Preschool; Chronic Disease; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Otitis Media; Postoperative Complications; Pulmonary Ventilation; Respiratory Insufficiency; Rhinitis, Allergic, Seasonal; Rhinoplasty; Speech Disorders; Time Factors; Tonsillitis

Topics: Adolescent; Adult; Animals; Antibodies; Antigen-Antibody Complex; Antigens; Asthma; Bronchi; Bronchodilator Agents; Desensitization, Immunologic; Hemagglutination; Histamine Release; Humans; Immune Sera; Immunoglobulin E; Immunoglobulin G; Indicators and Reagents; Leukocytes; Middle Aged; Mites; Nose; Precipitin Tests; Skin Tests; Vital Capacity

Topics: Adolescent; Airway Resistance; Anesthesia, Local; Asthma; Bronchi; Child; Chronic Disease; Cold Temperature; Female; Humans; Humidity; Lidocaine; Male; Nose; Pharynx; Pulmonary Ventilation; Sensory Receptor Cells; Spirometry; Temperature; Thermosensing; Ventilation-Perfusion Ratio; Vital Capacity

Topics: Asthma; Child; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Nose; Pharynx; Staphylococcus; Streptococcus; Trypsin Inhibitors

Topics: Adolescent; Adult; Asthma; Blood Cell Count; Child; Child, Preschool; Cockroaches; Diseases in Twins; Dust; Female; Fungi; Humans; Karyotyping; Male; Nose; Pharynx; Poaceae; Pollen; Radiography, Thoracic; Skin Tests; Staphylococcus; Tuberculin Test

Topics: Animals; Asthma; Desensitization, Immunologic; Horses; Humans; Hypersensitivity; Nose; Veterinary Medicine

Topics: Allergens; Asthma; Humans; Nose; Occupational Diseases; Platinum; Respiratory Hypersensitivity; Skin Tests; Spirometry

Topics: Asthma; Bronchitis; Epinephrine; Follow-Up Studies; Humans; Methods; Nose; Respiration; Respiratory Tract Diseases; Rhinitis, Allergic, Seasonal; Sampling Studies; Sinusitis; Surveys and Questionnaires; Tampons, Surgical

Topics: Acute Disease; Adolescent; Antibody Formation; Asthma; Child; Chronic Disease; Exocrine Glands; Female; Hemagglutination Inhibition Tests; Humans; Immunization; Immunoglobulin A; Immunoglobulins; Influenza Vaccines; Injections; Injections, Subcutaneous; Male; Neutralization Tests; Nose; Orthomyxoviridae

Topics: Adolescent; Adult; Aerosols; Aged; Allergens; Asthma; Bronchi; Child; Dust; Female; Fungi; Humans; Male; Medical History Taking; Middle Aged; Nose; Skin Tests

Topics: Air; Air Microbiology; Asthma; Body Temperature; Body Temperature Regulation; Cross Infection; Eye; Germ-Free Life; Humans; Infections; Motion Pictures; Nose; Photography; Respiration; Respiratory Tract Infections; Rheology; Skin; Skin Diseases

Topics: Adolescent; Adult; Allergens; Asthma; Bacteria; Bronchi; Dust; Female; Fungi; Humans; Hypersensitivity; Male; Nose; Pharynx; Trachea

Topics: Asthma; Humans; Nose

Topics: Adolescent; Ampicillin; Asthma; Bacteria; Child; Child, Preschool; Chloramphenicol; Erythromycin; Female; Haemophilus; Haemophilus influenzae; Humans; Male; Nose; Novobiocin; Penicillin Resistance; Pharynx; Staphylococcus; Streptococcus; Streptomycin; Sulfonamides; Tetracycline

Topics: Asthma; Child; Child, Preschool; Eczema; Eosinophils; Female; Food Hypersensitivity; Humans; Infant; Male; Mast Cells; Nose; Secretory Rate

Topics: Asthma; Child; Humans; Infant; Nose; Staphylococcal Infections; Streptococcal Infections

Topics: Adenoidectomy; Adolescent; Asthma; Bronchial Diseases; Bronchial Spasm; Child; Constriction, Pathologic; Focal Infection; Humans; Nasal Cavity; Nose; Palatine Tonsil; Respiratory Tract Infections; Tonsillectomy; Tonsillitis

Topics: Acetylcholine; Adolescent; Asthma; Humans; Nose; Skin Tests

Topics: Asthma; Humans; Hypersensitivity; Nose; Thuja; Trees; Wood

Topics: Asthma; Child; Diagnosis, Differential; Humans; Nose; Respiratory Tract Infections; Trachea; Virus Diseases

Topics: Asthma; Edema; Eosinophilia; Humans; Hypersensitivity; Nasal Polyps; Nose; Paranasal Sinuses; Rhinitis, Allergic, Seasonal; Sinusitis

Topics: Asthma; Child; Communicable Diseases; Humans; Infant; Nose; Respiratory Tract Infections

Topics: Asthma; Humans; Nose; Respiratory Tract Infections

Topics: Asthma; Eosinophilia; Humans; Hydrocortisone; Leukocyte Disorders; Nose

Topics: Asthma; Ear; Humans; Larynx; Nose; Otorhinolaryngologic Surgical Procedures; Sinusitis

Topics: Asthma; Child; Eosinophilia; Humans; Hypersensitivity; Infant; Nose; Nose Diseases; Vaccination

Topics: Asthma; Humans; Nose; Rhinitis, Allergic, Seasonal

Topics: Ammonium Compounds; Asthma; Child; Humans; Infant; Nose; Quaternary Ammonium Compounds; Respiratory Tract Infections

Topics: Asthma; Humans; Nose; Respiratory Tract Infections; Sinusitis; Trachea

Topics: Antigens, Bacterial; Asthma; Humans; Immunotherapy, Active; Nose; Vaccines

Topics: Adult; Asthma; Bronchi; Bronchoscopy; Fistula; Humans; Nose; Paranasal Sinuses

Topics: Asthma; Foreign Bodies; Humans; Maxillary Sinus; Nose; Paranasal Sinus Diseases; Postoperative Hemorrhage

Topics: Asthma; Diagnosis, Differential; Humans; Larynx; Nose; Trachea

Topics: Asthma; Humans; Nose; Pharynx

Topics: Asthma; Diagnosis, Differential; Humans; Larynx; Nose; Trachea

Topics: Asthma; Humans; Hypersensitivity; Nose; Respiratory Tract Diseases; Rhinitis, Allergic, Seasonal

Topics: Asthma; Humans; Nose; Polyps

Topics: Asthma; Humans; Neck; Nose; Pharynx

Topics: Asthma; Humans; Nose