The Clinical Relationship of Nasal Polyp to Asthma
Presented on April 21, 1997 by Sang-Joon Shin,
M.D.
Supervised by Kyung Shik Suh, M.D.
I. The Frequency of Polyps in Asthmatics
Incidence of nasal polyp : 0.2 - 1 % in adult,
United Kingdom
0.43/thousand/yr in Sweden
Incidence of asthma : 5.2 % in DK
Frequency of Polyps in Asthma
overall : 6.7 %
10-50 YO : 7 %
over 40 YO : 10-15 %
ASA intolerance : 36 - 96 %
II. The Frequency of Asthma in Nasal Polyposis
2 series from allergy clinics : high frequency of
asthma , 71 -72%
Those referred to ethmoidectomy : average frequency of asthma -
29.9%
ASA intolerance - 12.8%
Higher M/F ratio, Lower frequency of asthma & ASA intolerance
All nasal polyp Pts are NOT prone to asthma or ASA intolerance
Metacholine challenge in nonasthmatics c nasal polyp : No
evidence of lower airway
hyperreactivity in all Pts
M : F Ratio = 2-3 : 1 in nasal polyp
1 : 2 in asthma
The development of asthma after the onset of nasal polyp occurs
more often in female compaired to man.
Female c polyp is more prone to develop asthma than male c polyp.
III. Age and Onset of Asthma and Polyps
In unselected series
- Asthma : mean age of onset = 32-38 YO, average = 35 YO
- Polyps : mean age of onset = 39-47.5 YO, average = 42 YO
Asthma is no influent to the mean age of polyp onset
In selected groups of Pts c ASA intolerance, asthma and nasal
polyp
- Asthma : mean age of onset = 39.6-41 YO, average = 40.5 YO
- Polyps : mean age of onset = 44-45.1 YO, average = 45 YO
Pts c polyp, asthma & ASA intolerance showed later onset
of both asthm a and polyps.
The relationship between the onset of asthma & polyps
53 - 88% (69%) : asthma developed first
the mean interval from onset of asthma to the development of
polyp : 6-13 Yrs
22 - 33% (28%) : polyp developed first
16% : to develop for 5-26 Yrs
9.2-10% : simultaneous development of asthma & polyps
The onset of asthma & ASA intolerance usually occurred within
1 Yrs
IV. Lower Airway Response to Polyp Treatment
No relationship between polypectomy &
development of asthma.
No change of metacholine challenge test before & after
polypectomy.
30% : reduction of bronchial reactivity on metacholine test after
sphenoethmoidectomy
Most Pts : benefit or unchanged in the control of asthma after Op
Deterioration of asthma in small Pts : variations of an
underlying disease process shared
by polyp & asthma
Nasobronchial reflex : bronchoconstriction on nasal stimulation
acute attack of asthma during nasal op ?
anesthetic or other medical condition, exposure of lower airway
to secretion, nasal packing
mechanisms :
1. Stimulation of H1 receptor, irritant receptor or
cholinergic receptor (trigeminal-vagal pathway)
2.Bacterial seeding : infected sinus -- lower airway
increased ß-adrenergic blockade by lower airway infection
The improvement of the lower airway function
after Op
: Relieving nasal obstruction--> normalizing the
humidification & rewarming of air
The acute attack of asthma : not seem to be quantitatively large
problem (2%)
during Op : 20/101 Pts (pre-op severe asthma : 17)
17/1163 Pts
2/100 Pts
immediate post-op : 40%, most Pts-severe asthma
tranditional Op > FESS
local anesthesia > general anesthesia
prevention : proper medical & anesthetic care before &
during Op
Pre-op active asthma, local anesthesia Op : with consideration !
V. Upper airway Response to Polyp Treatment
Recurrence rate :
ASA intolerance > asthma > non-asthma
* older age : high recurrence rate
VI. Summary
1. A strong relationship between nasal polyp
& asthma
2. A common underlying disease process for Pts c nasal polyp
& asthma.
3. ASA intolerance c asthma & polyp can be separated from
asthma c polyp ?
4. Not all nasal polyp develop asthma
5. Nasal polyp s asthma : higher M/F ratio, lower recurrence rate
than ASA intolerance or
asthma Pts c nasal polyp
6. Identification of subgroup of nasal polyp : need to be
investigated
References
1. Knud Larsen, M.D. Allergy and Asthma Proc. September-October 1966, Vol. 17, No 5
2. Niels Mygind, M.D. Essential Allergy. Blackwell, London, 1986