xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

use of CFTR modulators (ie, ivacaftor and natural polyphe nols) has been proposed as a method with which to treat acquired CFTR and mucociliary dysfunction. 915–923 Studies have shown that ivacaftor augments ASL depth, acceler ates MCC, and pharmacologically reverses acquired CFTR dysfunction due to cigarette smoke exposure. 909 Treatment of infection in a rabbit model of Pseudomonas aeruginosa RS resulted in improvement in acquired mucociliary dys function (CFTR and ciliary function). 924,925

TABLE IX-17 Evidence for ciliary derangements as a contributing factor for CRSsNP Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Tipirneni 899 2018 3 Quantification of mucus strand velocity in CRS vs control explants CRS and control sinonasal mucosal explants Methacholine stimulated mucociliary velocity Methacholine-stimulated mucus strand Chen 877 2006 3 Quantification of stimulated CBF inCRSvs control explants CRS and control sinonasal mucosal explants ATP-stimulated CBF Exogenously applied ATP causes a 50% to 70% increase in CBF in control tissue, Scadding 911 1995 4 CBF inCRS patients at baseline and after 3 months of antibiotics velocity is significantly decreased in mucosal explants from CRS subjects compared to those from control subjects.

while CRS explants do not demonstrate similar increases in CBF in response to ATP.

10 CRS subjects CBF CBF was significantly increased in all subjects following a 3 month antibiotic course.

Ciliary Derangements as a Contributing Fac tor for CRSsNP Aggregate Grade of Evidence: C (Level 3: 2 studies, Level 4: 1 study; Table IX-17).

IX.C.14 Contributing Factors for CRSsNP: Immunodeficiencies In the subset of adult patients who have CRS that is refractory to usual therapy, primary immunodeficiency (PID) should be considered. The most common clinical manifestations of PID include RS, chronic otitis media, and chronic lung diseases (CLDs) such as pneumonia and bronchiectasis. 926–932 An association between hypoim munoglobulinemia and CRS has been described in the lit erature and multiple studies have demonstrated PID as a risk factor for the development of CRS. 492,493,929,930,933–940 The association is further strengthened in that other stud ies show an increased incidence and prevalence of RS in patients with immune dysfunction. 493,926,927,941 CVID, specific antibody deficiency (SAD), X-linked hypogammaglobulinemia, and several other disorders of humoral immunity are frequently referenced as con tributing factors to chronic or recurrent recalcitrant RS. 40,928,931,932,939,942–944 A number of selective Ig defi ciencies, specifically those involving IgG3 subclass, IgA, and IgM, have been consistently identified in this group of patients. 492,493,804,927,929,930,933,936,938–942,945–949 Pre immunization antipneumococcal titers have shown to be decreased as well, particularly in patients with the more severe forms of immunodeficiency such as CVID; patients with refractory RS can also demonstrate poor functional antibody responses to immunization. 492,493,941,943 Treat ment with IV immunoglobulin (IVIG) for Ig replacement in subsets of patients with humoral immunodeficiency has shown some benefit in clinical outcomes. 931,948–951