UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Relationships between rhinosinusitis and asthma

Authors
Stephen F Kemp, MD
Richard D deShazo, MD
Section Editor
Jonathan Corren, MD
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

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".)

          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Aug 16 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Slavin RG. The upper and lower airways: the epidemiological and pathophysiological connection. Allergy Asthma Proc 2008; 29:553.
  2. Greenberger PA. Allergic rhinitis and asthma connection: treatment implications. Allergy Asthma Proc 2008; 29:557.
  3. Togias A. Rhinitis and asthma: evidence for respiratory system integration. J Allergy Clin Immunol 2003; 111:1171.
  4. Simons FE. Allergic rhinobronchitis: the asthma-allergic rhinitis link. J Allergy Clin Immunol 1999; 104:534.
  5. Wright AL, Holberg CJ, Martinez FD, et al. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics 1994; 94:895.
  6. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc 1994; 15:21.
  7. Linneberg A, Henrik Nielsen N, Frølund L, et al. The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study. Allergy 2002; 57:1048.
  8. Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol 2002; 109:419.
  9. Bousquet J, Lockey R, Malling HJ, et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases. World Health Organization. American academy of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81:401.
  10. Bousquet J, Van Cauwenberge P, Khaltaev N, et al. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001; 108:S147.
  11. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8.
  12. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126:466.
  13. Sibbald B, Rink E. Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax 1991; 46:895.
  14. Leynaert B, Bousquet J, Neukirch C, et al. Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol 1999; 104:301.
  15. Shamssain MH, Shamsian N. Prevalence and severity of asthma, rhinitis, and atopic eczema in 13- to 14-year-old schoolchildren from the northeast of England. Ann Allergy Asthma Immunol 2001; 86:428.
  16. Sichletidis L, Chloros D, Tsiotsios I, et al. The prevalence of allergic asthma and rhinitis in children of Polichni, Thessaloniki. Allergol Immunopathol (Madr) 2004; 32:59.
  17. Spector SL, Bernstein IL, Li JT, et al. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998; 102:S107.
  18. Settipane GA, Chafee FH. Nasal polyps in asthma and rhinitis. A review of 6,037 patients. J Allergy Clin Immunol 1977; 59:17.
  19. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis and management. J Allergy Clin Immunol 1999; 104:5.
  20. Chan-Yeung M, Malo JL. Occupational asthma. N Engl J Med 1995; 333:107.
  21. Johnston SL, Pattemore PK, Sanderson G, et al. The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis. Am J Respir Crit Care Med 1996; 154:654.
  22. Green RM, Custovic A, Sanderson G, et al. Synergism between allergens and viruses and risk of hospital admission with asthma: case-control study. BMJ 2002; 324:763.
  23. Bresciani M, Paradis L, Des Roches A, et al. Rhinosinusitis in severe asthma. J Allergy Clin Immunol 2001; 107:73.
  24. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332:133.
  25. Oswald H, Phelan PD, Lanigan A, et al. Outcome of childhood asthma in mid-adult life. BMJ 1994; 309:95.
  26. Huovinen E, Kaprio J, Laitinen LA, Koskenvuo M. Incidence and prevalence of asthma among adult Finnish men and women of the Finnish Twin Cohort from 1975 to 1990, and their relation to hay fever and chronic bronchitis. Chest 1999; 115:928.
  27. Plaschke PP, Janson C, Norrman E, et al. Onset and remission of allergic rhinitis and asthma and the relationship with atopic sensitization and smoking. Am J Respir Crit Care Med 2000; 162:920.
  28. Shaaban R, Zureik M, Soussan D, et al. Rhinitis and onset of asthma: a longitudinal population-based study. Lancet 2008; 372:1049.
  29. van den Nieuwenhof L, Schermer T, Bosch Y, et al. Is physician-diagnosed allergic rhinitis a risk factor for the development of asthma? Allergy 2010; 65:1049.
  30. 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; 120:863.
  31. Martin PE, Matheson MC, Gurrin L, et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades. J Allergy Clin Immunol 2011; 127:1473.
  32. Shaver JR, O'Connor JJ, Pollice M, et al. Pulmonary inflammation after segmental ragweed challenge in allergic asthmatic and nonasthmatic subjects. Am J Respir Crit Care Med 1995; 152:1189.
  33. Bonay M, Neukirch C, Grandsaigne M, et al. Changes in airway inflammation following nasal allergic challenge in patients with seasonal rhinitis. Allergy 2006; 61:111.
  34. Pelikan Z. Asthmatic response induced by nasal challenge with allergen. Int Arch Allergy Immunol 2009; 148:330.
  35. Chanez P, Vignola AM, Vic P, et al. Comparison between nasal and bronchial inflammation in asthmatic and control subjects. Am J Respir Crit Care Med 1999; 159:588.
  36. Gaga M, Lambrou P, Papageorgiou N, et al. Eosinophils are a feature of upper and lower airway pathology in non-atopic asthma, irrespective of the presence of rhinitis. Clin Exp Allergy 2000; 30:663.
  37. Braunstahl GJ, Kleinjan A, Overbeek SE, et al. Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients. Am J Respir Crit Care Med 2000; 161:2051.
  38. ten Brinke A, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol 2002; 109:621.
  39. Arshad SH, Kurukulaaratchy RJ, Fenn M, et al. Rhinitis in 10-year-old children and early life risk factors for its development. Acta Paediatr 2002; 91:1334.
  40. Ramsdale EH, Morris MM, Roberts RS, Hargreave FE. Asymptomatic bronchial hyperresponsiveness in rhinitis. J Allergy Clin Immunol 1985; 75:573.
  41. Townley RG, Ryo UY, Kolotkin BM, Kang B. Bronchial sensitivity to methacholine in current and former asthmatic and allergic rhinitis patients and control subjects. J Allergy Clin Immunol 1975; 56:429.
  42. Ramsdale EH, Morris MM, Roberts RS, Hargreave FE. Bronchial responsiveness to methacholine in chronic bronchitis: relationship to airflow obstruction and cold air responsiveness. Thorax 1984; 39:912.
  43. Gerblich AA, Schwartz HJ, Chester EH. Seasonal variation of airway function in allergic rhinitis. J Allergy Clin Immunol 1986; 77:676.
  44. Tepas EC, Litonjua AA, Celedón JC, et al. Sensitization to aeroallergens and airway hyperresponsiveness at 7 years of age. Chest 2006; 129:1500.
  45. Cirillo I, Pistorio A, Tosca M, Ciprandi G. Impact of allergic rhinitis on asthma: effects on bronchial hyperreactivity. Allergy 2009; 64:439.
  46. Ciprandi G, Cirillo I, Pistorio A, et al. Impact of allergic rhinitis on asthma: effects on bronchodilation testing. Ann Allergy Asthma Immunol 2008; 101:42.
  47. Yilmaz O, Bakirtas A, Ertoy Karagol HI, et al. Allergic rhinitis may impact the recovery of pulmonary function tests after moderate/severe asthma exacerbation in children. Allergy 2014; 69:652.
  48. Hansen JW, Thomsen SF, Nolte H, Backer V. Rhinitis: a complication to asthma. Allergy 2010; 65:883.
  49. Ciprandi G, Signori A, Tosca MA, Cirillo I. Spirometric abnormalities in patients with allergic rhinitis: Indicator of an "asthma march"? Am J Rhinol Allergy 2011; 25:e181.
  50. Kaufman J, Wright GW. The effect of nasal and nasopharyngeal irritation on airway resistance in man. Am Rev Respir Dis 1969; 100:626.
  51. Yan K, Salome C. The response of the airways to nasal stimulation in asthmatics with rhinitis. Eur J Respir Dis Suppl 1983; 128 (Pt 1):105.
  52. Corren J, Adinoff AD, Irvin CG. Changes in bronchial responsiveness following nasal provocation with allergen. J Allergy Clin Immunol 1992; 89:611.
  53. Schumacher MJ, Cota KA, Taussig LM. Pulmonary response to nasal-challenge testing of atopic subjects with stable asthma. J Allergy Clin Immunol 1986; 78:30.
  54. Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis 1978; 118:65.
  55. Hallani M, Wheatley JR, Amis TC. Enforced mouth breathing decreases lung function in mild asthmatics. Respirology 2008; 13:553.
  56. Brugman SM, Larsen GL, Henson PM, et al. Increased lower airways responsiveness associated with sinusitis in a rabbit model. Am Rev Respir Dis 1993; 147:314.
  57. Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64:564.
  58. Bardin PG, Van Heerden BB, Joubert JR. Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis. J Allergy Clin Immunol 1990; 86:82.
  59. Denburg JA, Sehmi R, Saito H, et al. Systemic aspects of allergic disease: bone marrow responses. J Allergy Clin Immunol 2000; 106:S242.
  60. Wallaert B, Desreumaux P, Copin MC, et al. Immunoreactivity for interleukin 3 and 5 and granulocyte/macrophage colony-stimulating factor of intestinal mucosa in bronchial asthma. J Exp Med 1995; 182:1897.
  61. Braunstahl GJ, Overbeek SE, Kleinjan A, et al. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol 2001; 107:469.
  62. Corren J, Adinoff AD, Buchmeier AD, Irvin CG. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma. J Allergy Clin Immunol 1992; 90:250.
  63. Foresi A, Pelucchi A, Gherson G, et al. Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis. J Allergy Clin Immunol 1996; 98:274.
  64. Nair A, Vaidyanathan S, Clearie K, et al. Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis. Allergy 2010; 65:359.
  65. Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol 2002; 109:57.
  66. Adams RJ, Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J Allergy Clin Immunol 2002; 109:636.
  67. Dahl R, Nielsen LP, Kips J, et al. Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma. Allergy 2005; 60:875.
  68. Lohia S, Schlosser RJ, Soler ZM. Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis. Allergy 2013; 68:569.
  69. Corren J, Manning BE, Thompson SF, et al. Rhinitis therapy and the prevention of hospital care for asthma: a case-control study. J Allergy Clin Immunol 2004; 113:415.
  70. Warner JO, ETAC Study Group. Early Treatment of the Atopic Child. A double-blinded, randomized, placebo-controlled trial of cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18 months' treatment and 18 months' posttreatment follow-up. J Allergy Clin Immunol 2001; 108:929.
  71. Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 2000; 105:917.
  72. Möller C, Dreborg S, Ferdousi HA, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol 2002; 109:251.
  73. Niggemann B, Jacobsen L, Dreborg S, et al. Five-year follow-up on the PAT study: specific immunotherapy and long-term prevention of asthma in children. Allergy 2006; 61:855.
  74. Novembre E, Galli E, Landi F, et al. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 2004; 114:851.
  75. Polosa R, Al-Delaimy WK, Russo C, et al. Greater risk of incident asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: a retrospective cohort study. Respir Res 2005; 6:153.
  76. Passalacqua G, Durham SR, Global Allergy and Asthma European Network. Allergic rhinitis and its impact on asthma update: allergen immunotherapy. J Allergy Clin Immunol 2007; 119:881.
  77. Jacobsen L, Niggemann B, Dreborg S, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy 2007; 62:943.
  78. Schmitt J, Schwarz K, Stadler E, Wüstenberg EG. Allergy immunotherapy for allergic rhinitis effectively prevents asthma: Results from a large retrospective cohort study. J Allergy Clin Immunol 2015; 136:1511.
  79. Babu KS, Arshad SH, Holgate ST. Anti-IgE treatment: an update. Allergy 2001; 56:1121.
  80. Tsao CH, Chen LC, Yeh KW, Huang JL. Concomitant chronic sinusitis treatment in children with mild asthma: the effect on bronchial hyperresponsiveness. Chest 2003; 123:757.
  81. Manning SC, Wasserman RL, Silver R, Phillips DL. Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. Arch Otolaryngol Head Neck Surg 1994; 120:1142.
  82. Senior BA, Kennedy DW. Management of sinusitis in the asthmatic patient. Ann Allergy Asthma Immunol 1996; 77:6.