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Original Research: ASTHMA |

Upper and Lower Airway Patency Are Associated in Young Children

Bo Lund Krogsgaard Chawes, MD; Eskil Kreiner-Møller; Hans Bisgaard, MD, DMSci
Author and Funding Information

From the Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark.

Correspondence to: Hans Bisgaard, MD, DMSci, Copenhagen Prospective Studies on Asthma in Childhood, Danish Pediatric Asthma Center, Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Ledreborg Allé 34, 2820 Gentofte, Denmark; e-mail: bisgaard@copsac.com


Funding/Support: Supported by The Lundbeck Foundation, The Pharmacy Foundation of 1991, The Danish Medical Research Council, The Danish Pediatric Asthma Center, The Danish Lung Association, and Hans Skoubys og hustru Emma Skoubys Fond and Oda Pedersens Legat.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1332-1337. doi:10.1378/chest.09-2601
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Background:  Although allergic rhinitis and asthma frequently coexist, the nature of this association is poorly understood. Therefore, we examined whether upper and lower airway patency are associated.

Methods:  We investigated 221 6-year-old children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort, assessing upper airway patency by acoustic rhinometry before and after α-agonist, and lower airway patency by spirometry before and after β2-agonist. Furthermore, we measured blood eosinophil count, nasal eosinophilia, total IgE, and fraction of exhaled nitric oxide. Associations were investigated by generalized linear models.

Results:  Decongested nasal airway patency and post-β2 FEV1 were significantly associated (P = .007). The association remained significant after adjustments for sex, body size, FVC, and atopic diseases (β-coefficient 2.85 cm3; 95% CI, 0.42 to 5.29; P = .02). Baseline values of upper and lower airway patency were also significantly associated (β-coefficient 0.89 cm3; 95% CI, 0.26-1.51; P = .01). In addition, blood eosinophil count and nasal eosinophilia were inversely associated with decongested nasal airway patency, β-coefficient –0.42 cm3 (95% CI, –0.77 to –0.07; P = .02) and β-coefficient –0.47 cm3 (95% CI, –0.89 to –0.05; P = .03), respectively.

Conclusions:  We found a strong and consistent association between upper and lower airway patency. This may be due to a common pathology, as suggested by the inverse association between decongested nasal airway patency, blood eosinophil count, and nasal eosinophilia. Alternatively, the association between upper and lower airway patency might reflect a physiologic background for the common comorbidity.

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