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