A ‘Short Report’ in the Primary Care Respiratory Journal (2009); 18(3): 224-226, caught my attention. It addresses the effect of acute rhinosinusitis on pulmonary function in patients who have no chronic airways diseases or allergies.
Previously researches had noted that Chronic Obstructive Pulmonary Disease (COPD) patients have a high frequency of nasal symptoms and abnormalities in the paranasal sinuses on CT scanning, and that frequently patients with existing asthma later get a worsening of their lower airways disease with acute or chronic sinusitis problems. The influence of acute rhinosinusitis on lower airway function in patients without chronic airway diseases or allergy had not been investigated.
This study, carried out in a general practice in Denmark by two physicians, and reported by Associate Professor Jens Georg Hanson of the Aarhus University Hospital, Denmark, looked at 25 adult patients with a diagnosis of acute rhinosinusitis who presented with facial pain, anterior discharge and a CRP (C-reactive protein) value > 10 mg/l( normal < 8 mg/l). All patients with recurrent acute rhinosinusitis, asthma, COPD, allergy, and any condition or chronic disease that could modify the CRP levels were excluded.
Spirometry was used to measure pulmonary function, with the patients being tested at their initial visit, and again 8 weeks later when the rhinosinusitis had resolved. The results showed that the acute episode was associated with a temporary but significant reduction in F25-75 and in PEF, with no significant changes in FEV1 and FVC. There was a significant correlation between CRP and F25-75, but not with CRP and PEF. There was a significant correlation between changes in F25-75 and PEF, but no correlation between pain score and F25-75 or PEF.
The researchers suggest that a possible explanation of the changes might be small airway obstruction and air trapping, but as this finding was not expected, the researchers did not test if any slight obstruction in the small airways was reversible to inhaled bronchodilators. The author speculates that the significant correlation between the inflammation expressed as elevated values of CRP and the reduction in F25-75 points to the fact that the small airways are likely to be inflamed. It was suggest that further investigations be carried out to confirm and make clearer, the findings.
I wonder what pulmonary function changes are present in patients with recurrent acute rhinosinusitis, and their lung function prognosis.
Heather
Previously researches had noted that Chronic Obstructive Pulmonary Disease (COPD) patients have a high frequency of nasal symptoms and abnormalities in the paranasal sinuses on CT scanning, and that frequently patients with existing asthma later get a worsening of their lower airways disease with acute or chronic sinusitis problems. The influence of acute rhinosinusitis on lower airway function in patients without chronic airway diseases or allergy had not been investigated.
This study, carried out in a general practice in Denmark by two physicians, and reported by Associate Professor Jens Georg Hanson of the Aarhus University Hospital, Denmark, looked at 25 adult patients with a diagnosis of acute rhinosinusitis who presented with facial pain, anterior discharge and a CRP (C-reactive protein) value > 10 mg/l( normal < 8 mg/l). All patients with recurrent acute rhinosinusitis, asthma, COPD, allergy, and any condition or chronic disease that could modify the CRP levels were excluded.
Spirometry was used to measure pulmonary function, with the patients being tested at their initial visit, and again 8 weeks later when the rhinosinusitis had resolved. The results showed that the acute episode was associated with a temporary but significant reduction in F25-75 and in PEF, with no significant changes in FEV1 and FVC. There was a significant correlation between CRP and F25-75, but not with CRP and PEF. There was a significant correlation between changes in F25-75 and PEF, but no correlation between pain score and F25-75 or PEF.
The researchers suggest that a possible explanation of the changes might be small airway obstruction and air trapping, but as this finding was not expected, the researchers did not test if any slight obstruction in the small airways was reversible to inhaled bronchodilators. The author speculates that the significant correlation between the inflammation expressed as elevated values of CRP and the reduction in F25-75 points to the fact that the small airways are likely to be inflamed. It was suggest that further investigations be carried out to confirm and make clearer, the findings.
I wonder what pulmonary function changes are present in patients with recurrent acute rhinosinusitis, and their lung function prognosis.
Heather
Thanks Heather. A good reminder that we should at least note in the report if patients have upper respiratory infections when they perform spirometry. GPs should also be aware of this.
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