Can Nose Polyps Make Asthma Worse ?

Chronic rhinosinusitis (CRS) is a common disease in the otorhinolaryngology field in Japan. Previously, CRS mostly consisted of chronic inflammation caused by occlusion of the sinus ostia. Recently, however, CRS with nasal polyps (NPs), in which distinct eosinophilic infiltration can be observed, is rapidly increasing. This latter disease is called eosinophilic chronic rhinosinusitis (ECRS) in Japan.  in Europe and the United States, CRS characterized by eosinophilic inflammation is called chronic hyperplastic eosinophilic sinusitis (CHES), eosinophilic mucin rhinosinusitis (EMRS)4 or chronic hyperplastic rhi-nosinusitis with nasal polyposis (CHS/NP).5 Each of these conditions can be considered to be similar to ECRS. Moreover, CRS has recently been divided into two subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP).Ishitoya et al reported that the concept of ECRS in Japan would be applicable for Nasal polyps in Europe and the United States. The relationship between nasal polyps and asthma has been known for a long time. However, it is not fully understood. An epidemiological study reported that 93% of patients with EMRS were associated with asthma and that 54% of these patients had aspirin¬intolerant asthma (AIA).4 Another study reported that 50% of CHS/NP patients were associated with asthma and that about 30-40% of these patients had AIA.5 Thus, ECRS is an eosinophilic inflammation that can affect not only the nose and sinuses but also the bronchi, and can be considered to be an airway disease consistent with the concept of “one airway, one disease”. There have been epidemiological studies on upper airway diseases in Japan from the aspect of asthma.However, from the aspect of nasal polyps, no large studies on the relationship between nasal polyps and lower airway diseases have been reported to date. In this study, we conducted a large-scale survey among multiple institutions (six university hospitals).
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Best Way To Diagnose Nasal Polyps

The diagnostic criteria for Nasal polyps were defined by the clinical symptoms (nasal obstruction, discolored discharge (anterior/posterior nasal drip) or reduction/ loss of smell) for more than 12 weeks, plain X-ray imaging and computed tomographic (CT) scanning. The patients were asked about the disease duration, whether they had an olfactory dysfunction (anosmia/ hyposmia) and whether they had a history of surgery for sinus diseases. The presence or absence of an olfactory dysfunction was determined based on the patient’s complaints. Plain X-ray examination, CT scanning and endoscopy were performed on all patients. The presence or absence of nasal polyps was determined visually using an endoscope. Surgery was reserved for patients with nasal polyps or persistent cases after conservative medication for a few months. Local eosinophilic infiltration was evaluated pathologically using nasal polyps removed during surgery. The nasal polyps were stained with hematoxylin and e...
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