Sinusitis & Asthma

Rhoda Wynn, MD

Allergic rhinitis and asthma are both conditions in which there is inflammation of the affected airway. The symptoms of rhinitis are runny nose, stuffy nose, nose itching, sneezing and mucus dripping down the back of the nose. Asthma usually causes episodes of breathlessness, chest tightness and wheezing. The severity of both conditions can vary by season.

Allergic rhinitis and asthma are often present in the same patient. The presence of one condition can significantly affect the course of the other. A workshop of experts from around the world collaborated with the WHO (World Health Organization) to create a report called ARIA (Allergic Rhinitis and its Impact on Asthma). They found that irritation of the bronchial airway, a part of the lung, causes nasal inflammation and that nasal irritation causes bronchial inflammation.

Another airway disease is rhinosinusitis (what is generally called sinusitis). Rhinosinusitis symptoms include nasal blockage and congestion, nasal drainage, facial pain or pressure and loss of sense of smell. Since rhinosinusitis occurs more often in patients with allergic rhinitis, the three conditions are frequently seen together in patients. Most asthmatics have rhino sinusitis on CT scan. Severe chronic rhinosinusitis is seen more often in severe asthmatics than mild asthmatics. There is also a condition called aspirin-exacerbated respiratory disease (AERD), also called Samter’s triad, that is characterized by aspirin allergy, growths in the nose called nasal polyps, and asthma.

Combining strategies to treat both the upper airway disease (allergic rhinitis, sinusitis, nasal polyps) and lower airway disease (asthma) improves the effectiveness of treatment. Although there is limited information regarding the effectiveness of allergy treatment therapy in patients with rhinosinusitis, it is reasonable to consider adding allergy treatment for patients with both sinusitis and allergy. Patients with allergic rhinitis and rhinosinusitis that recurs frequently or does not respond well to treatment should be evaluated for the possible presence of asthma. Adding medications for allergic rhinitis to the treatment for asthmatic patients can improve control of asthma. Endoscopic sinus surgery for the treatment of rhinosinusitis and nasal polyps in patients with asthma also appears to improve asthma control.


References:
Bousquet JL, 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 Apr;63 Suppl 86:8-160.

Bousquet JL, Schünemann HJ, Samolinski B, et al. World Health Organization Collaborating Center for Asthma and Rhinitis. Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012 Nov;130(5):1049-62.
Am J Rhinol Allergy. 2012 May-Jun;26(3):187-90. doi: 10.2500/ajra.2012.26.3762.

Feng CH, Miller MD, Simon RA. The united allergic airway: connections between allergic rhinitis, asthma, and chronic sinusitis. Am J Rhinol Allergy. 2012 May-Jun;26(3):187-90.

Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013 Oct;3(10):788-94.

 


Revised 01/20/2015
©American Rhinologic Society