Asthma, Allergy, & Sinusitis

Allergic rhinitis and asthma represent two of the most common disorders diagnosed in the U.S. today.  Historically they have often been evaluated and managed as separate diseases.  Recent literature and medical opinion however have now moved towards unifying the management and treatment of airway disorders, utilizing the concept of the “Unified Airway”.

The unified airway represents the idea that both the upper airway (nasal cavity, sinuses, and throat) and the lower airway (bronchi and lungs) are linked through various complex pathways.  Simply stated, this means that disease at one site may have a significant effect on the other.  The proposed pathways are complex, but may include the following:

  • Direct interaction such as when post nasal drainage travels directly to the lungs exacerbating asthma disease
  • Systemic interaction caused by various inflammatory mediators released into the blood stream
  • Neural interaction pathway such as when irritation of the nasal lining nasal causes  reflexive bronchial constriction and asthma flareups

What is the significance of the “Unified Airway”

For patients with a diagnosis of allergic rhinitis, asthma, and/or chronic sinusitis controlling symptoms must involve management and treatment of each disorder.  Numerous studies have shown that adequately managing allergic rhinitis and or chronic sinusitis can significantly improve asthma symptoms and pulmonary function testing.  When these cases are severe it is critical that treatment consist of a multi disciplinary approach with involvement of physicians from multiple specialties of medicine including otolaryngology, allergy, pulmonology, and primary care.