Peripheral nitric oxide is increased in rhinitic patients with asthma compared to bronchial hyperresponsiveness

Allergic rhinitis is a predisposing factor for developing clinical asthma. Moreover, allergic rhinitis is often associated with bronchial hyperresponsiveness (BHR). We hypothesise that patients with asthma have more small airway involvement than those with allergic rhinitis and BHR alone. The aim of this study was to assess peripheral and proximal NO concentration in rhinitic subjects, and to correlate the peripheral NO concentration to the peripheral obstruction in response to methacholine. Patients with allergic rhinitis with or without BHR, or clinical asthma were investigated in and out of the allergy season. Healthy subjects served as controls. Fractional exhaled NO was performed, and peripheral NO concentration and proximal flux of NO was calculated. Methacholine test was performed including impulse oscillometry. Rhinitic patients with asthma demonstrate an increase in both proximal and peripheral NO compared to those with rhinitis alone or those with BHR. There is a trend of increased peripheral NO from patients with rhinitis only, rhinitis and BHR, to rhinitis with asthma. The increase in peripheral NO correlated with an increased peripheral obstruction in response to methacholine. Patients with seasonal allergic rhinitis demonstrated a decrease in both proximal and peripheral NO in the off-season. The results support our hypothesis that rhinitic patients with asthma have more peripheral lung inflammation and small airway involvement compared to rhinitic patients with BHR alone.