Correlation between the Prostaglandin D2/E2 Ratio in Nasal Polyps and the Recalcitrant Pathophysiology of Chronic Rhinosinusitis Associated with Bronchial Asthma

ABSTRACTBackgroundThe prevalence of patients with chronic rhinosinusitis (CRS) refractory to traditional therapy appears to be on the increase. In these cases, CRS tends to be associated with bronchial asthma (BA), especially, aspirin-intolerant asthma (AIA). On the other hand, arachidonic acid metabolites have been extensively investigated in the pathogenesis of BA. We sought to assess the role of prostaglandin D2 (PGD2) and prostaglandin E2 (PGE2) in the recalcitrant pathophysiology of CRS.MethodsSamples were prepared from the nasal polyps and mucosa of 40 patients undergoing endoscopic sinus surgery (ESS) at our hospital. The nasal polyp specimens obtained from the patients with CRS were divided into three groups, as follows: the CRS-AIA group, consisting of specimens obtained from patients with CRS complicated by AIA, the CRS-ATA group, consisting of specimens obtained from patients with CRS associated with aspirin-tolerant asthma (ATA), and the CRS-NA group, consisting of specimens obtained from CRS patients without BA. PGD2 and PGE2 were extracted from the specimens and quantified.ResultsThe concentrations of PGD2 were significantly higher in the nasal polyps of the CRS-ATA group. The concentrations of PGE2 were lowest in the nasal polyps of the CRS-AIA group. The PGD2/PGE2 ratio was highest in the CRS-AIA group.ConclusionsIt has previously been reported that CRS complicated by AIA is most likely to be characterized by repeated remissions and relapses, and is thus the most intractable. We may therefore say that the PGD2/PGE2 ratio reflects the intractable nature of CRS.