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Review
. 2009 Jan;15(1):19-24.
doi: 10.1097/MCP.0b013e32831da87e.

Rhinosinusitis and asthma: the missing link

Anne E Dixon  1
Affiliations
Review

Rhinosinusitis and asthma: the missing link

Anne E Dixon. Curr Opin Pulm Med. 2009 Jan.

Abstract

Purpose of review: Disease of the nose and sinuses is the most common comorbidity associated with asthma. Rhinitis, sinusitis and asthma may represent part of one disease process with manifestations at different sites. The purpose of this review is to highlight significant new findings on the epidemiological and pathophysiological link between the upper and lower airway. Finally, we will review recent data assessing the impact of treating sinonasal disease on both the development of asthma and asthma control.

Recent findings: Studies illustrate that rhinitis is very common in asthma, and associated with worse asthma control. Rhinitis typically precedes the development of asthma. Even in patients with rhinitis without asthma, there is evidence of subclinical change in the lower airways as measured by physiological changes and the presence of inflammatory mediators. There is much interest on the impact of treating allergic rhinitis on the development of asthma.

Summary: Rhinitis, sinusitis and asthma are likely part of one disease process. Treatment of established rhinitis may have some impact on measures of airway obstruction, but an effect on lower airway inflammation is yet to be established. Prospective studies are required to determine whether treatment of rhinitis can prevent the development of asthma, or decrease airway inflammation to improve asthma outcomes in those with established asthma or both.

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Figures

Figure 1
Figure 1
Functional Relationship between upper and lower airway: inflammation in the nose, sinuses and lungs is characterized by similar inflammatory profile, and disease severity in nose and sinuses parallels that in the lungs of asthmatics
Figure 2
Figure 2
Gradation of airway disease
Figure 3
Figure 3
Potential Opportunities for intervention in the development of asthma?
See this image and copyright information in PMC

References

    1. Dixon AE, Kaminsky DA, Holbrook JT, et al. Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function. Chest. 2006 Aug;130(2):429–35. - PubMed
    1. Burgess JA, Walters EH, Byrnes GB, et al. Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: a longitudinal study. J Allergy Clin Immunol. 2007 Oct;120(4):863–9. A longitudinal study of participants in the Tasmanian Asthma Study, originally enrolled in 1968, now followed over a 36 year period which found that childhood allergic rhinitis increased likelihood of subsequently developing asthma and having persistent asthma into middle age. - PubMed
    1. Almqvist C, Li Q, Britton WJ, et al. Early predictors for developing allergic disease and asthma: examining separate steps in the ‘allergic march’. Clin Exp Allergy. 2007 Sep;37(9):1296–302. A report from the Childhood Asthma Prevention Study that examined predictors for developing asthma which found that eczema, but not wheeze, asthma or rhinitis predicted the subsequent development of sensitization. - PubMed
    1. Lowe AJ, Hosking CS, Bennett CM, et al. Skin prick test can identify eczematous infants at risk of asthma and allergic rhinitis. Clin Exp Allergy. 2007 Nov;37(11):1624–31. A study of an Australian birth cohort which found that atopy in children with eczema predicted the development of childhood asthma. - PubMed
    1. Polosa R, Knoke JD, Russo C, et al. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin Immunol. 2008 Jun;121(6):1428–34. A study of an Italian adult population followed at an outpatient allergy clinic which reports that smoking predicts the later development of asthma in patients with allergic rhinitis. - PubMed

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