Bronchiectasis and sinonasal diseases: a narrative review

Abstract

Bronchiectasis and chronic rhinosinusitis are chronic diseases of the upper and lower respiratory tract characterised by both infective and inflammatory pathways. The two share many clinical, radiological, microbiological and pathophysiological aspects. Bronchiectasis and chronic rhinosinusitis may be characterised by different endotypes, with inflammation driven by either neutrophils and/or eosinophils. Although the two conditions may coexist, the prevalence of their association remains uncertain. To date, few studies have investigated the pathogenetic relationship between these disorders, with ambiguous results obtained in heterogeneous populations. Some findings suggest that patients with both chronic rhinosinusitis and bronchiectasis may have a heavier disease burden consisting of more exacerbations, more debilitating symptoms, higher radiological severity and worse quality of life. In light of this, identification of treatable traits is crucial and patients are likely to benefit from a multidisciplinary approach involving, among others, pulmonologists, ear-nose-throat physicians, respiratory physiotherapists and allergists/immunologists.

FIGURE 1

Pathophysiology of the unified airways model. The interplay between microbiological and inflammatory features associated with upper and lower respiratory tract diseases. Type 2-high (T2-high) and neutrophilic inflammatory pathways can possibly be targeted by specific interventions that interrupt the vicious cycle. Th-1: T-helper 1; Th-3: T-helper 3; IL: interleukin; DPP-1: dipeptidyl peptidase 1.