Rhinosinusitis in Children and Asthma Severity

Ruby Pawankar; Mario E. Zernotti, MD, PhD


Curr Opin Allergy Clin Immunol. 2009;9(2):151-153. 

In This Article

Abstract and Introduction


Purpose of Review: Rhinosinusitis is a common condition in children. The association between rhinosinusitis and asthma is supported by strong epidemiological and pathogenic evidence. Moreover, a close relationship between sinusitis and asthma severity has also been reported. This study shows the new findings in this strong relationship.
Recent Findings: The profile of inflammatory cells and inflammatory mediators seen in both conditions bears considerable similarity, especially in both diseases with a relevant role played by eosinophils.
Summary: Severe asthma is uncommon in childhood, but there is compelling evidence showing that the most severe asthma is closely associated to upper respiratory illness, especially rhinosinusitis. Treatment of chronic rhinosinusitis, medical or surgical or both, benefits concomitant asthma and has been shown to reduce the severity of asthma.


Recent studies in both children and adults have suggested that rhinosinusitis and asthma are manifestations of a common inflammatory process rather than entirely separate diseases that only act locally. In fact, upper respiratory illness (URI) often influences lower airway disease.[1] Rhinosinusitis is a common condition in children, and it is usually overlooked.

There is strong evidence of a relationship between rhinosinusitis and asthma based on epidemiological and pathogenic aspects. Moreover, there is a close relationship with asthma severity indicating the significantly important role of severe chronic upper airway disease on lower airway disease. From a pathogenic point of view, many inflammatory cells and mediators and the cells are often common to both conditions, with a relevant role played by eosinophils.

It is well known that asthma and rhinosinusitis, with or without polyps, are the most common chronic diseases in the general population. Samter's triad, asthma, nasal polyps, and NSAIDs intolerance, although frequent in adults, is not common in children.

The prevalence of rhinitis in asthmatics is about 70-80%, whereas the prevalence of one of the most frequent comorbidities of allergic rhinitis such as rhinosinusitis remains unclear. A recent study[2•] on the prevalence of rhinosinusitis in asthmatic population has shown it to be about 35%. In addition, two study groups reported prevalence between 41 and 51%.[3]


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