Sinusitis and Asthma: Related Airway Diseases

Abstract

In clinical practice, sinusitis commonly occurs in patients with asthma. In fact, upper airway symptoms and supportive radiographic changes of rhinosinusitis appear to be present in about 50% of all asthmatics.^(1-6) Histologically, sinusitis and asthma share an important inflammatory pathophysiologic component—the eosinophil. Based on the observations of several clinical studies, it appears that aggressive medical, surgical, or both sinus treatments can also markedly improve the lower airway disease in these patients. This fact strongly suggests that sinusitis occasionally may have a causative role in the initiation or exacerbation of chronic asthma. We begin with a historical review of evidence for the coexistence of sinusitis and asthma, and then focus on evidence that the eosinophil plays a central role in the pathophysiology of both airway inflammatory disorders. Next, we examine the effect of medical and surgical sinus therapy on concommitant asthma. We conclude with comments and speculation on the possible mechanisms by which sinusitis might cause or aggravate asthma, leading to important clinical implications for patient care.