Dr. Mohamed Ib. EletrebiConsultant Allergy & Clinical
Immunology.
Is There a Link Between Asthma and Rhino Sinusitis?
nAsthma more likely to develop in people with Rhino Sinusitis
Allergic Rhinitisinusitis
Colds Asthma
Ear Infections
Sinus Infections
Spector SL. J Allergy Clin Immunol. 1997;99:S773-S780.
Nasal Polyps
URI=upper respiratory infections.
OME=otitis media with effusion.
Allergic rhino
Sinusitis
Does Allergy Cause Sinusitis?
Annual US incidence of sinusitis = 35 + million
In adult patients, CT demonstrated association between extensive sinus disease and:Allergy in 78% of patients
RhinosinusitisMore accurate term than “sinusitis” since
almost always preceded by or concomitant symptoms of rhinitis Acute – Up to 4 weeksSubacute – 4 to 12 weeksChronic – > 12 weeks
OME = Otitis media with effusion. *Control group.Adapted from Tomonaga et al. Acta Otolaryngol (Stockh). 1988;458(suppl):41.
What About Ear Infections in Children?
SchoolChildren (N=104)*
Nasal AllergyChildren (N=605)
7.9% 21%
QuestionsWhat is the relationship between allergic
rhinitis and asthma?
Is there any interaction between upper and lower airways?
What are the mechanisms that may play a role in nasobronchial cross-talk?
Pathogenesis allergic airway disease
Genetic factors
Environmental factors
Atopic sensitization
Structural changes
Mucosal inflammation
Phenotype
80-95% of asthmatic patients have rhinitis.
76% asthmatic patients reported presence of rhinitis before onset asthma.
Asthma presence associated with duration and severity of rhinitis.
Epidemiology
Leynaert, J Allergy Clin Immunol 2004
rhinitis
asthma
Dis
ease
sev
erity
time
Togias, Allergy 1999
SummaryMucosal inflammation is present
in the entire airway of patients with allergic rhinitis and/or asthma.
Upper airway inflammation is associated with bronchial hyperresponsiveness
Lower airway remodeling is present in asthmatic, but also in allergic rhinitis patients.
InflammationInflammationInflammation
QuestionsWhat is the relationship between allergic
rhinitis and asthma?
Is there any interaction between upper and lower airways?
What are the mechanisms that may play a role in nasobronchial cross-talk?
Baseline
nose
lung
VCAM-1 Eosinophils
Allergic inflammationAllergic inflammation
Nasal inflammation after SBP
Before100 x
After
MBP
bronchial challenge
Summary
The interaction between nose and lung in allergic airways disease is a bi-directional process
GINA Guideline clearly states that THERE IS NO CURE FOR ASTHMA, But appropriate management most often leading to CONTROL of asthma
For Which Patients? Patients diagnosed with
allergic asthma Patients diagnosed with
allergies such as hay fever
Patients diagnosed with sinusitis that predisposes them to asthma
Patients diagnosed with insect sting allergy
Case : Mr. Ahmed is 25 years old patient. He is a known case of asthma for 5 years on salbutamol inhaler, And CS complaining of asthma, repeated cough and frequent use Antibiotics.
Asthma Attack start with Cold mostlyIn between attack Suffer from PND and
Headach Also Mostly Nocturnal cough.Cold Recurrence prior appear asthma with
10 yrs Past history tonsil and adenoid extract at 5
yrs age Father suffer from chronic sinusitis
What is your diagnosis?What is the treatment?
Answer:
1. Partially controlled asthma
2. Mild asthma with chronic rhino sinusitis
3. Moderate asthma with chronic rhino sinusitis
Take home messagesAllergic rhinitis often precedes asthma.Allergic rhinitis and asthma characterized
by global airway inflammation.There is a bi-directional influence
between upper and lower airways.The systemic pathway plays an important
role in the interaction between nose and lung