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Diagnostic classification of persistent rhinitis and its relationship to exhaled nitric oxide and asthma. A clinical study of a consecutive series of patients

¹Allergologia e Immunologia Clinica, University of Torino, Italy -- Ospedale Mauriziano Umberto I -- Largo Turati 62 -- 10128 -- Torino (Italy) ²Otorinolaringoiatria, Ospedale Mauriziano Umberto I -- Largo Turati 62 -- 10128 -- Torino (Italy) ³Laboratorio Analisi, Ospedale Mauriziano Umberto I -- Largo Turati 62 -- 10128 -- Torino (Italy) ⁴Dipartimento di Scienze Biomediche ed Oncologia Umana -- Università di Torino -- Via Genova 3 -- 10126 -- Torino (Italy)

grolla{at}mauriziano.it

Abstract

BackgroundRhinitis and asthma represent the manifestation of one syndrome. Our hypothesis is that in patients with symptoms of persistent rhinitis, lower airway inflammation, lower respiratory symptoms and lung function abnormalities compatible with asthma are more frequently associated with the diagnosis of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) than with non allergic rhinitis (NAR).

Methods108 out of 590 consecutive patients referred in one year for rhinitis were enrolled on the basis of nasal symptoms lasting >4 weeks. Asthma was diagnosed on the basis of symptoms and a positive bronchodilating test and/or methacholine hyperresponsiveness. Exhaled nitric oxide (FE_NO) was measured with the single exhalation method at 50 ml/s.

ResultsAR was diagnosed in 39%, NAR in 21% and CRS in 40 %. The prevalence of asthma was significantly higher in AR (33%) and CRS (42%) than in NAR (8.7%), p= 0.036 and p = 0.005 respectively. FE_NO was significantly higher in patients with AR and CRS compared to patients with NAR (44.3 ppb CI95%: 34-54 ppb, 53 ppb CI95%: 42-64 ppb versus 22 CI95%: 18-27 ppb, p=0.002 and p=0.001 respectively).

Patients with asthma had FE_NO values significantly higher than patients without asthma (64 ppb CI95%: 51-77 ppb versus 33.3 ppb CI95%: 28-39 ppb p<0.001).

ConclusionsThe diagnostic classification of persistent rhinitis helps to predict lower airway inflammation (increased FE_NO) and prevalence of asthma: AR and CRS are associated with higher mean FE_NO values and higher prevalence of asthma than NAR.

Key Words: allergy • asthma • chronic rhinosinusitis • exhaled breath analysis • exhaled nitric oxide • rhinitis

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				M. Olivieri, M. Malerba, G. Talamini, and M. Corradi Reference Values for Exhaled Nitric Oxide in the General Population Chest, March 1, 2008; 133(3): 831 - 832. [Full Text] [PDF]