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Comment on: nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis. Delclaux C, et al

We read with interest the recent paper by Delclaux et al. [1] on nitric oxide (NO) flux in the upper and lower airway in nasal polyposis. Their conclusion, however, that ‘the medical treatment of nasal polyposis improves both airway reactivity and obstruction, whatever the presence of asthma, suggesting a functional link between the upper and lower airway functions’ is not supported by the data they present. Their results show no significant improvement in airway hyperreactivity or conducting airway NO flux in the predominant, non-asthmatic group. The only statistical improvements they demonstrate in forced expiratory volume in 1 s and FEF25–75 are of dubious clinical significance by their own admission. While the authors present interesting evidence for nasal NO as a significant outcome measure of treatment for polyposis, we should be cautious of over-interpreting this as evidence of a functional link between upper and lower airways in patients with chronic rhinosinusitis who do not have asthma [2].