In allergic asthma, don’t neglect the upper airway



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The idea of upper and lower airway diseases is a construct of medical disciplines rather than our understanding of the disease process, says Sydney rhinologist Professor Richard Harvey.

“Pathophysiologically, in terms of the disease process, the idea of one airway, one disease makes a lot of sense,” says Professor Harvey, who is Professor of Rhinology and Skull Base at the University of NSW and Macquarie University.

Some investigators have referred to allergic rhinitis, asthma and chronic sinusitis as a “united airways disease”, suggesting that these conditions may be differing manifestations of the same inflammatory process within the airway rather than fully separate diseases.1 Based on this hypothesis, upper airway conditions such as allergic rhinitis may worsen the natural course of lower airway diseases such as asthma.1

More than 80% of people with asthma have rhinitis, and 15–30% of patients with rhinitis have asthma.1

Professor Harvey says: “If you have clinical evidence of reactivity in one part of the airway, you’ve almost certainly got the same response to some degree throughout the whole system, whether it’s clinically apparent or not.”

This interplay between upper and lower airways may explain why it’s crucial to address seasonal allergic rhinitis in patients with allergic asthma.