Pulmonary arterial pressure and nasal obstruction in mouth‐breathing children: Similarities between adenotonsillar hypertrophy and allergic rhinitis

• Published in: International forum of allergy & rhinology Vol. 11; no. 2; pp. 128 - 135
• Main Authors: Ferreira Nader, Carolina Maria Fontes, Capanema, Flávio Diniz, Franco, Letícia Paiva, Meira, Zilda Maria Alves, Galvão, Cláudia Pena, Ramos, Vinícius Malaquias, Tinano, Mariana Maciel, Torres, Lucas Lima, Guimarães, Roberto Becker, Becker, Helena Maria Gonçalves
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2021
• Subjects: Airway management; Allergic rhinitis; Blood pressure; Children; Doppler echocardiography; Doppler effect; Echocardiography; Etiology; Hypertrophy; Mouth; mouth breathing; nasal airway obstruction; pulmonary hypertension; Respiration; rhinomanometry; Doppler echocardiography; allergic rhinitis; mouth breathing; nasal airway obstruction; pulmonary hypertension; rhinomanometry
• ISSN: 2042-6976; 2042-6984; 2042-6984
• DOI: 10.1002/alr.22651

Background Upper airway obstruction may cause pulmonary hypertension in childhood. In this study we aimed to identify a possible correlation of systolic pulmonary arterial pressure (SPAP), using Doppler echocardiography, with nasal patency (NP), as measured by rhinomanometry, in mouth‐breathing (MB) children with allergic rhinitis (AR) and adenotonsillar hypertrophy (ATH). Methods In this cross‐sectional study we evaluated 183 patients, from 2 to 12 years of age, at an MB referral clinic in Brazil, from December 2013 to 2017. We allocated patients to 4 etiology groups: group 1, 60 MBs with ATH; group 2, 47 MBs with AR; group 3, 43 MBs with both ATH and AR; and group 4, 33 nasal breathing control subjects. The ratio of total nasal inspiratory flow (assessed by active anterior rhinomanometry) and expected inspiratory flow adjusted for height determined the percent NP (%NP). Results The median %NP was higher in controls than in the MB groups (controls, 114% [79‐147%]; ATH: 65% [5‐116%]; AR: 57% [23‐144%]; ATH and AR: 64% [3‐120%]; p < 0.001). Median SPAP was higher in the MB groups than in controls (SPAP: ATH, 26.0 [20.0‐35.0] mmHg; AR, 26.0 [22.0‐32.0] mmHg; ATH and AR, 26.30 [20.0‐34.0] mmHg; control, 22.0 [16.0‐30.0] mmHg; p < 0.001). SPAP showed a negative association with %NP (Spearman's rho = −0.24; p < 0.001). Conclusion Reduced nasal airflow in MB children showed a correlation with higher levels of systolic pulmonary arterial pressure. The AR and ATH groups were similar in nasal obstruction severity and systolic pulmonary arterial pressure level distribution.