SEQUENTIAL EVALUATION OF PULMONARY-FUNCTION AND BRONCHIAL HYPERRESPONSIVENESS IN PATIENTS WITH NASAL POLYPOSIS - A PROSPECTIVE-STUDY

Nasal polyposis (NP) is commonly associated with nonspecific bronchial hyperresponsiveness (BHR) and/or asthma. The aim of this prospective study was to investigate the changes of pulmonary function and BHR in patients with nasal polyposis. Forty-four consecutive patients with NP were included in the study and were followed for 12 mo. Nonspecific B HR was assessed by a carbachol challenge test to determine the provoca ting dose (PD20) necessary to decrease FEV(1) by 20% from baseline val ues; 17 of 22 patients who demonstrated BHR also exhibited asthma. Spi rometric measurements and carbachol challenge were performed before in itiating any treatment and 12 mo later. All patients were treated firs t with beclomethasone (600 mu g/d). Intranasal ethmoidectomy was perfo rmed in 23 patients who did not improve when treated with topical ster oids alone (nonresponders); in contrast, 21 patients were successfully treated with beclomethasone alone (responders). PD20 significantly de creased in the group of nonresponders (p = 0.018), whereas it remained unchanged in responders (p = 0.95). FEV(1) (% pred) and FEF(25-75) (% pred) significantly decreased in nonresponders (p < 0.001), whether B HR existed or not, whereas no significant change was observed in respo nders. Our results demonstrate that nonresponders who required nasal s urgery exhibited an enhancement of BHR and a slight but significant de crease of FEV(1) and FEF(25-75) values. However, no change in pulmonar y symptoms and/or asthma severity occurred. Clinical and functional fo llow-up of these patients should assess the long-term evolution of the se parameters and their clinical relevance.