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Review
. 2019 Feb 11;7(2):27.
doi: 10.3390/medsci7020027.

Regulation of Interaction between the Upper and Lower Airways in United Airway Disease

Akira Kanda  1   2 , Yoshiki Kobayashi  3   4 , Mikiya Asako  5   6 , Koichi Tomoda  7 , Hideyuki Kawauchi  8 , Hiroshi Iwai  9
Affiliations
Review

Regulation of Interaction between the Upper and Lower Airways in United Airway Disease

Akira Kanda et al. Med Sci (Basel). .

Abstract

The concept of united airway disease comprises allergic rhinitis (AR) with asthma, and eosinophilic chronic rhinosinusitis (ECRS) with asthma. It embodies a comprehensive approach to the treatment of upper and lower airway inflammation. The treatment of upper airway inflammation reduces asthma symptoms and decreases the dose of inhaled corticosteroids (ICS) necessary to treat asthma. However, little is known about the mechanisms of interaction between upper and lower airway inflammation. Here we review these mechanisms, focusing on neural modulation and introduce a novel therapeutic approach to united airway disease using a fine-particle ICS. Our understanding of the relationship between the upper and lower airways and its contribution to T helper 2 (Th2)-skewed disease, such as AR and/or ECRS with asthma, has led us to this novel therapeutic strategy for a comprehensive approach to the treatment of upper airway inflammation with asthma.

Keywords: allergic rhinitis; asthma; eosinophil; nasal-bronchial reflex; united airway disease.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schema of mechanisms of interaction between upper and lower airway inflammation. Red line and dot-line indicate parasympathetic and trigeminal nerve, respectively. AR, allergic rhinitis; CNS, central nervous system; ECRS, eosinophilic chronic rhinosinusitis.
Figure 2
Figure 2
Neural pathway in allergic rhinitis; nasonasal reflex, nasal-ocular reflex, and nasal–bronchial reflex. CGRP, calcitonin gene-related peptide; SP, substance P; FcεR, Fc epsilon receptor
Figure 3
Figure 3
Schema of HFA-BDP ETN treatment; hydrofluoroalkane-134a-beclomethasone dipropionate (HFA-BDP) exhaled through the nose (ETN) treatment. Red dots indicate corticosteroids.
See this image and copyright information in PMC

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