Relationships between rhinosinusitis and asthma
- Stephen F Kemp, MD
Stephen F Kemp, MD
- Professor of Medicine and Pediatrics
- University of Mississippi Medical Center
- Richard D deShazo, MD
Richard D deShazo, MD
- Billy S Guyton Distinguished Professor
- Professor of Medicine and Pediatrics
- University of Mississippi Medical Center
Asthma and allergic rhinitis (rhinosinusitis) often coexist and may represent a spectrum of the same disease entity (one airway hypothesis) [1,2]. There is also a strong link between asthma and bacterial rhinosinusitis, viral upper respiratory infections (acute viral rhinosinusitis), and nasal polyposis.
Several experts propose that it is reasonable to consider patients with asthma as a subgroup of the larger population of patients with allergic rhinitis since allergic rhinitis is almost ubiquitous in patients with asthma [3-8]. Position papers on allergic rhinitis, generated at international workshops in collaboration with the World Health Organization (WHO) [9-12] and endorsed by the American Academy of Allergy, Asthma and Immunology (AAAAI) and by numerous other professional organizations internationally, have supported this view.
Rhinitis is defined as the presence of sneezing, rhinorrhea (anterior and posterior), nasal congestion, and/or nasal itching, arising from irritation and inflammation of the nasal passages. Rhinosinusitis describes disorders affecting both the nasal passages and paranasal sinuses. Symptoms of sinus involvement include nasal congestion, posterior nasal drainage, facial pressure and pain, headache, fatigue, and reduced sense of smell.
In most instances, the term "rhinosinusitis" is preferred to "sinusitis" since inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa. However, "rhinitis" can occur without "sinusitis." Patients with environmental allergies, especially seasonal (eg, pollens), can have rhinitis alone. In contrast, patients with perennial symptoms, usually associated with sensitization to indoor allergens (eg, dust mites, pet danders, fungi), often have prominent nasal congestion and posterior drainage, suggesting greater sinus involvement.
This topic reviews the epidemiologic, physiologic, and therapeutic evidence that supports the one airway hypothesis. Allergic rhinitis, acute and chronic rhinosinusitis, and asthma are covered in detail separately in numerous topics. (See "An overview of rhinitis" and "Pathogenesis of allergic rhinitis (rhinosinusitis)" and "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis" and "Pathogenesis of asthma" and "Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment".)
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