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Background <p>Chronic rhinosinusitis (CRS) has been increasingly linked to lower airway inflammation through shared inflammatory pathways within the unifiedairway. However, the extent to which inflammatory biomarkers reflect subclinical lower airway involvement in CRS patients without established asthma remains incompletely understood. To evaluate the association between inflammatory biomarkers and pulmonary function parameters in patients with CRS, with a focus on identifying features suggestive of subclinical lower airway inflammation. This prospective observational study included 121 adult patients diagnosed with CRS, excluding those with known asthma or chronic obstructive pulmonary disease. Upper airway symptom severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22). Inflammatory biomarkers including fractional exhaled nitric oxide (FeNO), absolute eosinophil count (AEC), and serum total IgE were measured. Pulmonary function testing was performed using spirometry. Associations between biomarkers, symptom severity, and lung function were assessed using Spearman correlation. Multivariate linear regression analysis was conducted to identify independent predictors of FeNO levels. FeNO demonstrated a modest but statistically significant positive correlation with SNOT-22 scores (ρ = 0.233, <i>p</i> = 0.010). No significant correlations were observed between FeNO and forced expiratory volume in one second (FEV₁), or between FEV₁ and either AEC or SNOT-22 scores. On multivariate analysis, SNOT-22 score (<i>p</i> = 0.010) and AEC (<i>p</i> = 0.049) emerged as independent predictors of FeNO, while serum IgE and age were not independently associated. Spirometric parameters were largely preserved, with no consistent evidence of clinically significant reversible airway obstruction. In CRS patients without established asthma, inflammatory biomarkers—particularly FeNO—demonstrate modest associations with upper airway symptom burden but not with spirometric airflow limitation. These findings suggest the presence of subclinical lower airway inflammatory involvement without overt functional impairment, supporting cautious interpretation of the unified airway concept in CRS. Further longitudinal studies are required to determine the clinical implications of these inflammatory patterns.</p>

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Association Between Asthma and Inflammatory Biomarkers in Chronic Rhinosinusitis Patients

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Rachit Pahwa,
  • Akshay Singh,
  • Nitika Gupta

摘要

Background

Chronic rhinosinusitis (CRS) has been increasingly linked to lower airway inflammation through shared inflammatory pathways within the unifiedairway. However, the extent to which inflammatory biomarkers reflect subclinical lower airway involvement in CRS patients without established asthma remains incompletely understood. To evaluate the association between inflammatory biomarkers and pulmonary function parameters in patients with CRS, with a focus on identifying features suggestive of subclinical lower airway inflammation. This prospective observational study included 121 adult patients diagnosed with CRS, excluding those with known asthma or chronic obstructive pulmonary disease. Upper airway symptom severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22). Inflammatory biomarkers including fractional exhaled nitric oxide (FeNO), absolute eosinophil count (AEC), and serum total IgE were measured. Pulmonary function testing was performed using spirometry. Associations between biomarkers, symptom severity, and lung function were assessed using Spearman correlation. Multivariate linear regression analysis was conducted to identify independent predictors of FeNO levels. FeNO demonstrated a modest but statistically significant positive correlation with SNOT-22 scores (ρ = 0.233, p = 0.010). No significant correlations were observed between FeNO and forced expiratory volume in one second (FEV₁), or between FEV₁ and either AEC or SNOT-22 scores. On multivariate analysis, SNOT-22 score (p = 0.010) and AEC (p = 0.049) emerged as independent predictors of FeNO, while serum IgE and age were not independently associated. Spirometric parameters were largely preserved, with no consistent evidence of clinically significant reversible airway obstruction. In CRS patients without established asthma, inflammatory biomarkers—particularly FeNO—demonstrate modest associations with upper airway symptom burden but not with spirometric airflow limitation. These findings suggest the presence of subclinical lower airway inflammatory involvement without overt functional impairment, supporting cautious interpretation of the unified airway concept in CRS. Further longitudinal studies are required to determine the clinical implications of these inflammatory patterns.