Rhinosinusitis in Children and Asthma Severity

Ruby Pawankar; Mario E. Zernotti, MD, PhD

Disclosures

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

In This Article

Relationship Between Asthma and Rhinosinusitis

Most recent evidence supports rhinosinusitis and asthma as two compartmental expressions of a common mucosal susceptibility to exogenous stimuli. In addition, there is evidence that the compartmental processes can affect and amplify each other via a systemic intermediary.[9] Nasal sinus disease may contribute to less asthma control in children. Children with severe asthma appear to have the most relevant abnormalities on CT scanning of the paranasal sinuses,[10•] again highlighting the importance of severe chronic upper airway disease and its impact on lower airway disease.

Although the precise mechanisms are still unclear, asthma and chronic sinusitis are associated frequently. CT is a sensitive tool for documenting sinonasal mucosal abnormalities. Crater et al.[11] studied the CT findings in patients with acute asthma. They concluded that the mucosal thickening in the nasal passages (P < 0.001) and sphenoidal, ethmoidal, and frontal sinuses are more common in patients with acute asthma than in controls. However, maxillary sinus mucosal thickening is not more common in asthmatic patients than in controls.[11] In another study[12] evaluating the radiographic findings in the asthmatic group compared with the nonasthmatic control group, the mean scores of the total mucosal changes (8.45 versus 4.67 points, P < 0.001), and total sinus scores (5.50 versus 2.69, P < 0.005) were significantly higher in the asthmatic group. Bresciani et al.[13] compared the presence of rhinosinusitis in patients with mild and severe asthma. The frequency of rhinosinusitis in patients with mild-to-moderate or severe steroid-dependent asthma was similar; however, sinonasal involvement, as evaluated by clinical symptoms and CT scan imaging, was significantly greater in the patients with severe steroid-dependent asthma than in those with mild-to-moderate asthma.[13] Talay et al.[14•] investigated the relationships between the presence of rhinosinusitis, sinus site involvement, and total CT sinus scores and the presence of allergy, allergen type, and severity of disease in 128 asthma patients and reported that the prevalence of chronic sinusitis was higher in patients with allergic asthma.

In another study[15•] of 121 patients with chronic rhinosinusitis, the authors concluded that patients with chronic rhinosinusitis when associated with nasal polyps and asthma constitute the most severe form of unified respiratory tract disease.

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