title: Association and management of eosinophilic inflammation in upper and lower airways.
abstract: This review discussed the contribution of eosinophilic upper airway inflammation includes allergic rhinitis (AR) and chronic rhinosinusitis (CRS) to the pathophysiology and course of asthma, the representative counterpart in the lower airway. The presence of concomitant AR can affect the severity of asthma in patients who have both diseases; however, it is still debatable whether the presence of asthma affects the severity of AR. Hypersensitivity, obstruction and/or inflammation in the lower airway can be detected in patients with AR without awareness or diagnosis of asthma, and AR is known as a risk factor for the new onset of wheeze and asthma both in children and adults. Allergen immunotherapy, pharmacotherapy and surgery for AR can contribute to asthma control; however, a clear preventive effect on the new onset of asthma has been demonstrated only for immunotherapy. Pathological similarities such as epithelial shedding are also seen between asthma and CRS, especially eosinophilic CRS. Abnormal sinus findings on computed tomography are seen in the majority of asthmatic patients, and asthmatic patients with CRS show a significant impairment in Quality of Life (QOL) and pulmonary function as compared to those without CRS. Conversely, lower airway inflammation and dysfunction are seen in non-asthmatic patients with CRS. Treatments for CRS that include pharmacotherapy such as anti-leukotrienes, surgery, and aspirin desensitization show a beneficial effect on concomitant asthma. Acting as a gatekeeper of the united airways, the control of inflammation in the nose is crucial for improvement of the QOL of patients with co-existing AR/CRS and asthma.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan. Electronic address: mokano@cc.okayama-u.ac.jp.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Okano
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Kariya
authors.affiliation: Department of Otolaryngology, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ohta
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Imoto
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Fujieda
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nishizaki
mesh_terms: D001249:Asthma / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D019468:Disease Management; D004802:Eosinophilia / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D012137:Respiratory System / Q000276:immunology / Q000503:physiopathology; D065631:Rhinitis, Allergic / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D012852:Sinusitis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy
keywords: Allergic rhinitis; Asthma; Chronic rhinosinusitis; Endoscopic sinus surgery; Immunotherapy