Bachert Claus, Patou Joke, Van Cauwenberge Paul
Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
Curr Opin Allergy Clin Immunol. 2006 Feb;6(1):29-36. doi: 10.1097/01.all.0000200504.54425.0e.
Some time ago, a link between upper and lower respiratory disease was described, which gave rise to the concept of 'united airways disease'. This concept primarily refers to the well established link between allergic rhinitis and asthma, but it also covers a possible link between sinus disease and asthma (allergic or nonallergic) and other lower airway disease.
The current classification of chronic rhinosinusitis (CRS) includes disease without and with nasal polyps, which are considered subgroups of CRS. Different patterns of inflammatory and regulatory cytokines (involving distinguishable T-helper lymphocyte populations) and of remodelling markers, however, were recently described to differentiate nasal polyposis from CRS, yielding two discrete entities. These patterns resemble those of lower airway diseases, such as asthma and chronic obstructive pulmonary disease, and suggest a common aetiological/pathogenetic background. Whereas the link between nasal polyps and asthma is well established (indeed, asthma improves after medical or surgical treatment of sinus disease), that between CRS and lower airway disease is not well understood. Recently, Staphylococcus aureus enterotoxins, acting as superantigens, were identified as a possible link between nasal polyps and asthma, resulting in severe disease manifestations in both upper and lower airways.
The role played by sinus disease in asthma is only partially understood, largely because of deficits in the clinical classification and in basic knowledge of pathophysiological pathways. Recent research into upper airway and sinus inflammation and remodelling may reveal new perspectives and lead to a classification of sinus disease, which will facilitate appropriate clinical and epidemiological studies.
一段时间以前，人们描述了上呼吸道疾病与下呼吸道疾病之间的联系，由此产生了“联合气道疾病”的概念。这一概念主要指变应性鼻炎与哮喘之间已明确的联系，但也涵盖了鼻窦疾病与哮喘（变应性或非变应性）及其他下呼吸道疾病之间可能存在的联系。
慢性鼻-鼻窦炎（CRS）的现行分类包括无鼻息肉和有鼻息肉的疾病，它们被视为CRS的亚组。然而，最近有研究描述了不同模式的炎症和调节性细胞因子（涉及不同的辅助性T淋巴细胞群体）以及重塑标志物，以区分鼻息肉病与CRS，从而产生了两个不同的实体。这些模式与哮喘和慢性阻塞性肺疾病等下呼吸道疾病的模式相似，提示存在共同的病因学/发病机制背景。虽然鼻息肉与哮喘之间的联系已得到充分证实（事实上，鼻窦疾病经药物或手术治疗后哮喘会改善），但CRS与下呼吸道疾病之间的联系尚不清楚。最近，作为超抗原起作用的金黄色葡萄球菌肠毒素被确定为鼻息肉与哮喘之间的可能联系，导致上、下呼吸道均出现严重的疾病表现。
鼻窦疾病在哮喘中所起的作用仅得到部分理解，这主要是因为临床分类和病理生理途径的基础知识存在不足。对上呼吸道和鼻窦炎症及重塑的最新研究可能会揭示新的观点，并促成鼻窦疾病的分类，这将有助于开展适当的临床和流行病学研究。
