Pembimbing :

dr. Agus Sudarwi, Sp.THT-KL

dr. Afif Zjauhari, Sp.THT-KL

Presented By :
Alfian Kusuma Saputra (012116317)
Desy Lila Nurdiana (012116362)
Fatya Nur Aninda (012116391)
Sultan Agung Islamic University Medical of Faculty
 Title : Influence of Chronic Sinusitis and
Nasal Polyp on the Lower Airway of Subjects
Without Lower Airway Disease

Author : Suh-Young Lee, Soon Ho Yoon,

Woo-Jung Song, So-Hee Lee, Hye-Ryun
Kang, Sun-Sin Kim, Sang-Heon Cho

Publish : Allergy Asthma Immunol Res.

2014 July. 6(4): 310-315 Received: March
27, 2013; Revised: July 4, 2013; Accepted:
September 12, 2013g. 2012;138(9):840-845
ABSTRACT

INTRUDUCTION

MATERIAL & Method

Result

Discussion

Inclusion
 This study
investigated the
association of CT
finding suggesting
PURPOSE chronic sinusitis
and lung function
in healthy subjects
without lung
disease
METODE

RESULT
Conclusion
• CT findings suggesting chronic
sinusitis and nasal polyp were
associated with subclinical
lower airway flow limitation
even in the absence of
underlying lung disease
 INTRODUCTION
Chronic sinusitis is an inflammatory disease
of the nose and sinus mucosa caused by a
disturbance of ventilation and nasal cavity
drainage
Chronic sinusitis is a common upper airway inflammatory
condition with a prevalence of 10.1% in the general population
in the USA and Nasal polyps usually occur in association with
chronic sinusitis

Chronic sinusitis is associated with lower airway

diseases such as asthma, chronic obstructive
pulmonary disease (COPD), and bronchiectasis
the concept of “united airway
disease” or “one linked airway
disease” means that upper and
lower airway diseases are
different manifestations of one
pathologic process

the potential effect of upper airway pathology on normal

lower airways has not been evaluated. Therefore, this
study investigated the impact of sinusitis or nasal polyp
on lower airway function in healthy subjects without
definite lung disease to prove a “united airway disease”
hypothesis in normal subjects
 Material and method
The basic health-
Criteria screening program :
Include & Health Quetionnaire,
Exclude Laboratory test,
Pulmonary Function Test

Assesment of sinuses
Statiscal
and nasal polyp
Analisis
 INCLUSION
SUBJECT
Patient who chose optional osteomeatal unit
computed tomography (OMU CT) as a basic
health screening program

PLACE
Seoul National University Hospital,
Healthcare System, Gangnam Center in Seoul,
South Korea

TIME

March 2004 – June 2010

 Exclusion criteria
Patient diagnosed with :
Questionnaire
The health questionnaire included :
a) smoking status
b) medication history
c) presence of respiratory symptoms
d) comorbid conditions : hypertension, diabetes,
and liver disease
Laboratory Test
Laboratory tests consisted :
a) complete blood cell counts
b) blood chemistry
c) lipid profiles
d) C-reactive protein levels
Pulmonary Fuctional Test
PFT included :
a) forced expiratory volume at 1 second (FEV1)
b) forced vital capacity (FVC)
A. The CT scoring system ranged from 0-30 points
1. 0 to 3 points for each of the 7 sinus areas ,
scores of mucosal thickening
2. 0 to 3 points for the nasal passage and each of the 2 osteomeatal
complex units ,
scores of the passage obstruction
Limited disease : < 12 points
Extensive disease: ≥ 12 points

B. The presence of a nasal polyp was assessed by the

protrusion of a polypoid lesion in the nasal cavity
with rhinoscopy.
1. The questionnaire and laboratory test results
were compared between groups with and
without CT findings to suggest sinusitis or
nasal polyps

VS
SINUSITIS ( Limited without SINUSITIS
and Extensive)

NASAL POLYP
VS WITHOUT NASAL
POLYP
A Fisher’s exact test and chi-square tests compared categorical
variables and a Student t-test was performed to compare
continuous variables between groups
2. lung function were compared with partial
correlation coefficients adjusted for variables
from the questionnaire and laboratory tests
3. The results of the PFTs were compared to
subgroups with a one-way ANOVA test with
a post-hoc analysis.
4. Statistical analyses were performed using an
SPSS package (SPSS 17.0, Inc., Chicago, IL,
USA)
*
 Table 1. Number of study subjects according to comorbid
status of sinusitis and nasal polyps

CT finding of sinusitis total

Absent Limited Extensive

Nasal polyp Absent 38 (90.5%) 93 (56.7%) 19 (24.4%) 150

Present 4 (9.5%) 71 (43.3%) 59 (75.6%) 134

Total 42 164 78 284

 Table 2. Demographic and clinical characteristics
according to CT finding of sinusitis or nasal polyps

CT finding of sinusitis Pvalue Nasal Polyp Pvalue

Absent Limited Extensive Absent Present
(n=42) (n=164) (n=78) (n=112) (n=130)

Male (%) 23 (54.8) 122 (74.4) 68 (87.2) <0.001 77 (68.8) 113 (86.9) <0.001
Age (year) 44.3±2.0 52.1±0.8 51.7±1.0 <0.001 51.9±1.0 52.1±0.8 0.907
BMI (kg/m2) 22.0±0.9 23.6±0.4 24.3±0.6 0.077 24.4±0.3 24.8±0.2 0.291
CRP 0.06±0.01 0.18±0.04 0.15±0.03 0.180 0.29±0.06 0.17±0.02 0.103
(mg/dL)
Eosinophil 171.4±21.5 215.8±15.5 259.9±19.1 0.036 213.1±18.1 244.6±16.6 0.200
(/uL)
Atopy (%) 51.9 47.1 50.0 0.763 42.7 (32/75) 58.7 (27/46) 0.274
(14/27) (32/68) (13/26)
Smoker (%) 8 (19.0) 29 (17.8) 20 (25.6) 0.357 17 (15.2) 32 (24.6) 0.079
Smoking 18.5±4.3 22.6±2.2 21.2±2.5 0.634 19.4±2.3 23.5±2.0 0.186
history
 TABLE 3. EFFECT OF CT FINDING OF SINUSITIS OR NASAL POLYPS ON
LUNG FUNCTION AND BRONCHIAL HYPERRESPONSIVENESS

CT Finding of sinusitis Pvalues Nasal Polyp PValue

Absent Limited Extensive Absent Present

(n=42) (n=164) (n=78) (n=112) (n=130)
FEV1 (predicted %) 106.0±2.0 102.8±1.2 98.1±1.8 0.013 103.6±1.3 100.0±1.2 0.027

FVC (predicted %) 97.0±2.0 96.6±0.8 95.1±1.4 0.559 96.4±1.0 96.0±1.0 0.795

FEV1/FVC (%) 84.2±1.0 79.1±0.7 76.6±0.8 <0.001 80.0±0.7 77.4±0.6 0.004

BHR (%) 0/26 (0.0) 7/64 (10.9) 5/25 (20) 0.007 4/45 (8.9) 8/44 (18.2) 0.230

CT score (point) 0.3±0.1 5.6±2.9 15.8±0.5 <0.001 6.7±0.5 10.8±0.5 <0.001

Figure . Patients’ lung function according to the presence of sinusitis and nasal polyp.
(A) Patients with both sinusitis and nasal polyp showed lower FEV1 than normal subjects.
(B) (B) FVC showed no difference between three groups. (C) FEV1/FVC of patients
(C) with both sinusitis and nasal polyp were significantly lower than that of patients
(D) with only sinusitis or normal subjects
 *
The main findings of our study were as
follows:
1) decreased lung function was correlated
with CT findings that suggested chronic
sinusitis and nasal polyp in subjects
without lower respiratory disease
2) theseverity of CT finding of sinusitis
was related to the degree of airway
obstruction
3) In recent decades, significant medical literature has
shown evidence of the association of asthma and
rhinosinusitis that has observed significant and
frequent sinonasal symptoms in patients with asthma
and especially severe asthma.

4) It is not clear whether rhinosinusitis triggers asthma

directly or if both conditions are simply manifestations
of a common disease process
There are hypothesis association of asthma and
rhinosinusitis :

1. nasopharyngobronchial reflexes may be involved in

airway hyperresponsiveness

2. local stimulation by inflammatory mediators might

trigger bronchospasme releasing chemotactic factors
and leukocytes that increase cell adhesion receptors
 Cont’
 This study has some limitations in the interpretation of
the results. First, selection criteria of subjects for OMU CT
and bronchial provocation tests are not clear.

 Second, it is not clear whether subclinical airflow

limitation is a result of suffering from chronic sinusitis or
a coincidental finding of chronic sinusitis .

 Longitudinal studies should be performed to investigate

and clarify the relationship of the reversibility of airway
limitation after sinusitis treatments in subjects without
lower lung disease
CONCLUSSIONS
CT findings suggests chronic sinusitis associated with a
subclinical airflow limitation in subjects without lower
respiratory disease. A united airway disease hypothesis may be
valid for subjects even without definite lung disease.