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

Treatment Outcomes and Integrated Approach

The effects of rhinosinusitis treatment on asthma are disputed. Rhinosinusitis plays an important role in initiating or exacerbating asthma. Some authors considered rhinosinusitis as a trigger factor, whereas others support the idea of comorbidity. In either case, rhinosinusitis has been shown to worsen the symptoms of asthma. Therefore, controlling upper airway infection, inflammation, and symptoms may also improve asthma outcomes. Medical and surgical treatments of chronic rhinosinusitis have been shown to be associated with subjective and objective improvement of asthma.

Tosca et al.[16] explored the effect of medical treatment for rhinosinusitis on asthma outcomes. Eighteen children were treated with a combination of amoxicillin and clavulanate (20 mg/kg twice daily) and fluticasone propionate aqueous nasal spray (100 μg/day) for 14 days. A short course of oral corticosteroids was also prescribed (deflazacort, 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days, and 0.25 mg/kg daily for 4 days). Asthma symptoms and lung function significantly improved after treatment, and 1 month later, a significant reduction in inflammatory cell numbers was detected in all asthmatic children. IL-4 levels significantly decreased (P < 0.001), whereas IFN-γ levels increased (P < 0.001).[16]

Tsao et al.[17] have suggested that the intensive treatment of sinusitis improves asthma symptoms. They studied 61 children with mild asthma and allergic rhinitis. Forty-one of these 61 children had sinusitis. One group was treated with amoxicillin-clavulanate for 6 weeks and then with nasal isotonic saline solution irrigation for 6 weeks. In the other group, the treatment order was reversed. Children without chronic sinusitis received nasal isotonic saline solution irrigation for 12 weeks. The clinical symptoms and signs of sinusitis, but not forced expiratory volume in 1 s (FEV-1),[1] showed a significant improvement after antibiotic treatment. After aggressive treatment of sinusitis, the dose of methacholine used for methacholine challenge that caused a 20% fall in FEV-1[1] in children with mild asthma and sinusitis was significantly higher after treatment of rhinosinusitis.[17]

Apart from medical treatment, sinus surgery has also been shown to have a positive impact on improving asthma. Ragab et al.[18] reported a randomized prospective study of surgery compared with medical therapy in chronic rhinosinusitis. Overall, asthma control improved significantly following both treatment modalities, but was better maintained after medical therapy.[18] On the contrary, Dejima et al.[19] studied the impact of asthma on chronic sinusitis. They conducted a prospective analysis of the outcome of 88 patients with or without bronchial asthma who underwent endoscopic sinus surgery (ESS) for chronic sinusitis. The outcomes of ESS on symptoms and objective findings related to sinusitis were significantly worse in the cases with comorbid asthma, but patients suffering from chronic sinusitis and bronchial asthma showed improvement following ESS in terms of their asthma symptoms, peak flow, and medication score.[19]

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