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Is there any link between nasal polyposis and lower airway?

RhinologyEuropean Rhinological society guidelines suggest that Chronic rhinosinusitis without nasal polypi and chronic rhinosinusitis with nasal polpi are two different entities

because mechanisms involved are different and hence management also differs.

Gleaning various research papers published in this topic the following generalizations can safely be made.

1. Nasal polyposis affect 2-5% of general population

2. Nasal polyposis is seen in 5% of atopic asthmatics

3. Nasal polyposis is seen in 13% of non atopic asthmatics

4. Course of nasal polyposis in asthmatics are generally severe

5. Aspirin induced asthma has the highest prevalance of nasal polyposis

6. Females with nasal polyposis are more likely to be asthmatics

7. Nasal polyposis in middle age females always indicate aspirin hypersensitivity

8. Presence of nasal polypi in children indicate cystic fibrosis / immunodeficiency

How nasal polypi affect lower airway?

Various mechanism have been postulated.

1. Nasal polypi impair basic functions of nasal mucosa (air conditioning, defence against microbes and viruses)

2. Micro aspiration of post nasal drip from sinuses to bronchi (irrelevant in consious individuals)

3. Systemic cross talk between nasal / sinus mucosa and the lower airway mucosa

4. Common inflammatory mediators involved in both upper and lower airway inflammations

5. Role of Cysteinyl Leukotreines in nasal polyposis and bronchial asthma – This is a most potent inflammatory mediator contributing to the symptoms of bronchial asthma

and nasal polyposis. It is known to increase microvascular permeability, mucous secretion, impairing muco ciliary clearance, induce long lasting

bronchospasm and recruitment of eosinophils into the nasal mucosa.

6. Role of microbes in bronchial asthma and nasal polyposis. Staph aureus has been commonly implicated.

7. Nasal polypi predispose to bronchial hyper reactivity

Management of nasobronchial syndrome:

1. Corticosteroids – systemic / topical

2. Leucotriene inhibitors – Monteleukast / zafirleukast

3. Zileuton – Potent 5-lipoxygenase inhibitor

4. Leucotriene receptor antagonists

5. Aspirin desensitisation

6. Antibiotics ???

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Is there any link between nasal polyposis and lower airway?
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