Nasal Disease and Asthma

Abstract

The nose plays a primary role within the airways, working as "a filter and air-conditioner", together with other important fnnctions. Thus, it is not surprising that nasal diseases are associated with several other comorbidities, including both upper and lower airways, such as bronchial hyperresponsiveness (BHR) and asthma. Several studies have investigated the relationship existing between the upper and the lower airways and new insights are rising. Nevertheless, some uncertainties still remain, mainly because nasal disorders are quite heterogeneous, overlapping (i.e. rhinitis-rhinosinusitis-sinusitis, acute or chronic, allergic or non-allergic) and difficult to diagnose, so that, frequently, many studies don't differentiate between the various conditions. For this reason, the purpose ofthis review is to systematically analyze present epidemiological, pathophysiological and clinical data on the relationship between nasal diseases and asthma, splitting up three main conditions: allergic rhinitis, chronic rhinosinusitis and nasal polyposis.The relationship between nasal diseases and asthma, even tough postulated many centuries ago (1), has been deeply investigated only during the last 20 years (2-4). The new approaches and studies on such a relationship have become possible mainly thanks to the introduction of new technologies, such as nasal flexible endoscopy (5).Nasal inflammatory disorders include a complex group of inflammatory conditions with great variability in presentation, diagnosis and management (6). Rhinitis and sinusitis, isolated or in association, are common diseases in the paediatric population and they can be classified as infectious or allergic, acute or chronic, and associated or not with nasal polyps (7). Typical signs and symptoms include nasal congestion, nasal purulence, postnasal drip, nasal discharge, hypo-osmia, fever, cough, facial pressure, halitosis, dental pain, ear fullness, and headache. The diagnosis and the management of rhinosinusitis are challenging, but usually not satisfactory.Asthma is a chronic inflammatory condition resulting in a reversible airway obstruction, and mainly characterised by dry cough, expiratory wheezing, chest tightness and dyspnoea: these signs and symptoms may be triggered by allergen exposure, infections, exercise or airways irritants (8). Although asthma is at present a common condition in paediatrics, the prevalence of uncontrolled asthma, as defined by the GINA classification (9), is low. Therefore, in case of non-controlled asthma, a special evaluation is required. In fact, as a first step, clinicians should initially verify an adequate compliance to the prescribed therapy and then re-evaluate if the initial diagnosis of asthma is correct. After this initial step, possible comorbidities have to be searched for, including psychiatric disorders, gastro-esophageal reflux, obesity, respiratory infections and nasal diseases.The recognized and accepted "unified airways" theory (10) links upper and lower airways: the mechanisms able to explain such a relati...

Rhinosinusitis and Asthma: A Very Long Engagement

“…According to some studies (8), asthma is more common in patients with moderate-to-severe persistent rhinitis; according to others, there is no correlation between ARIA categories of rhinitis and prevalence of asthma (9). Rhinitis is a significant and independent risk factor for asthma onset, as it often precedes bronchial hyperreactivity (1). AR has also been linked to "small airway disease", defined as a reduction in forced expiratory flow (PEP) at 25%-75% of the pulmonary volume and a normal spirometry, which is suggested to be an early marker of bronchial involvement in patients with rhinitis who perceive only nasal symptoms (10).…”

“…Large studies have found a link between the severity and/or control of both diseases in children and adults; in particular, poor asthma control is linked to moderate-severe rhinitis, which should be identified and treated (5). Numerous studies have also shown that treatment of AR will improve asthma outcome (1,5). According to some studies (8), asthma is more common in patients with moderate-to-severe persistent rhinitis; according to others, there is no correlation between ARIA categories of rhinitis and prevalence of asthma (9).…”

Rhinosinutis and Asthma in Children

“…The respiratory apparatus is anatomically divided into the upper and lower respiratory tracts and has the function of air conduction and gas exchange [6]. Although considered as different entities, the nose and the lung share several microscopic and macroscopic similarities [6].…”

“…Although considered as different entities, the nose and the lung share several microscopic and macroscopic similarities [6]. Histologically, both nose and bronchi are composed of pseudostratified respiratory epithelium with columnar ciliated cells.…”

“…Nasal polyposis (NP) is more frequently seen in men than in women [5], and in adolescents or elderly and asthmatic subjects [6]; it is less common in childhood [7,8]. NP may be either isolated or associated with other medical conditions.…”