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    Pembimbing: Dr. Agus Sudarwi, SP - THT-KL Dr. Afif Zjauhari, SP - THT-KL

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    1) A study investigated the association between CT findings of chronic sinusitis, nasal polyps, and lung function in healthy subjects without lung disease. 2) The study found decreased lung function correlated with more severe CT findings of chronic sinusitis and presence of nasal polyps. 3) Subjects with both chronic sinusitis and nasal polyps by CT showed lower lung function compared to subjects with only sinusitis or normal subjects.

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    Pembimbing: Dr. Agus Sudarwi, SP - THT-KL Dr. Afif Zjauhari, SP - THT-KL

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    annisapritas
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    1) A study investigated the association between CT findings of chronic sinusitis, nasal polyps, and lung function in healthy subjects without lung disease. 2) The study found decreased lung function correlated with more severe CT findings of chronic sinusitis and presence of nasal polyps. 3) Subjects with both chronic sinusitis and nasal polyps by CT showed lower lung function compared to subjects with only sinusitis or normal subjects.

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    1) A study investigated the association between CT findings of chronic sinusitis, nasal polyps, and lung function in healthy subjects without lung disease. 2) The study found decreased lung function correlated with more severe CT findings of chronic sinusitis and presence of nasal polyps. 3) Subjects with both chronic sinusitis and nasal polyps by CT showed lower lung function compared to subjects with only sinusitis or normal subjects.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    36 views25 pages

    Pembimbing: Dr. Agus Sudarwi, SP - THT-KL Dr. Afif Zjauhari, SP - THT-KL

    Uploaded by

    annisapritas
    1) A study investigated the association between CT findings of chronic sinusitis, nasal polyps, and lung function in healthy subjects without lung disease. 2) The study found decreased lung function correlated with more severe CT findings of chronic sinusitis and presence of nasal polyps. 3) Subjects with both chronic sinusitis and nasal polyps by CT showed lower lung function compared to subjects with only sinusitis or normal subjects.

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    © All Rights Reserved
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    of 25

    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.

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