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Forced expiration through the nose is a stimulus for NANIPER but not for controls
J P Braat1, W J Fokkens, P G Mulder
1Department of Ear-, Nose- and Throat Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. boon@kno.fgg.eur.nl
Objective:
Is forced expiration through the nose a mechanical stimulus to which patients with nasal hyperreactivity react? Do parameters, such as peak nasal expiratory flow rate (PNEF), influence nasal airway resistance (NAR) in these patients?
Method:
NAR, mucus production and sneezing were measured on 2 occasions two weeks apart. Measurements were conducted before and during a period of 10 minutes after 3 repeated PNEFs in 15 non-allergic non-infectious perennial rhinitis (NANIPER) patients suffering from nasal hyperreactivity, and in 15 controls.
Results:
In NANIPER versus controls PNEF measurements attributed to a statistically significant increase in NAR. The main effect was within the first minute after stimulus, suggesting a neuronal mechanism. Mucus secretions and sneezing were hardly present. PNEF (highest of 3) and bronchial peak expiratory flow rate (BpEFR) are lower in NANIPER than controls but are correlated. Impaired bronchial capacity is likely to influence PNEF, resulting in a lower decrease of nasal patency.
Conclusion:
PNEF depends on BpEFR and is an adequate mechanical stimulus for NANIPER patients, but not for non-rhinitic controls, resulting in a brief increase in NAR.