Long-term follow-up of pulmonary function in patients with nasal polyposis

The outcome of asthma and/or nonspecific bronchial hyperresponsiveness (BHR ) associated with nasal polyposis (NP) is uncertain. Over a 4-yr period, we investigated the long-term changes of pulmonary function and BHR in 46 pat ients with NP. Each subject was assessed for nasal symptoms and rested for allergy skin prick tests, serum total IgE, spirometry, and carbachol challe nge at baseline before initiating any treatment (T0). Nasal symptoms evalua tion, spirometric measurements, and carbachol challenge were repeated at T1 and at T2 (respectively, 12.7 +/- 0.9 and 47.9 +/- 2.2 mo after T0). In ad dition, bronchodilator response was measured at T2. At T0, 25 patients exhi bited BHR and 16 of 25 were asthmatic. All patients were treated first with topical steroids for 6 wk (beclomethasone 600 mu g/d). Eighteen patients w ere successfully treated with topical steroids (topical steroids responders ), Intranasal ethmoidectomy was performed in 28 patients who did not improv e with topical steroids alone (topical steroids nonresponders). Nasal score improved at T1 and remained improved at T2 as compared with T0 in both gro ups (p < 0.005), Topical steroids nonresponders demonstrated a significant decrease of FEV1, FEV1/FVC ratio, and FEF25-75 at T1 (p < 0.05) and at T2 ( p < 0.0005), whereas no significant change was observed in FEV1 and FEV1/FV C ratio in responders, Delta FEV1 (%) between T2 and T0 was not related to the presence of asthma, BHR, or atopy. Bronchodilator response at T2 was si milar in the two groups. BHR did not significantly change over the 4-yr fol low-up period in the two groups. No change in pulmonary symptoms and/or ast hma severity occurred. Our results show that nonreversible airflow obstruct ion appears over a 4-yr follow-up period In topical steroids nonresponders patients with NP requiring nasal surgery, The long-term contribution of the se changes to the development of respiratory symptoms in patients with NP r emains to be documented.