Kim Jung-Soo, Rubin Bruce K
Department of Otolaryngology, Kyungpook National University, Daegu, Korea.
COPD. 2007 Jun;4(2):163-6. doi: 10.1080/15412550701341228.
Epidemiologic studies suggest that as many as 75% of patients with COPD have concomitant nasal symptoms and more than 1/3 of patients with sinusitis also have lower airway symptoms of asthma or COPD. Because the inflammatory response of the upper and lower airways are similar, and both sites have a similar exposure to allergens and irritants, it is not surprising that rhinitis or sinusitis would coexist with COPD. Possible mechanisms of combined upper and lower airway dysfunction include the so-called nasal-bronchial reflex, inflammation caused by smoking, mouth breathing caused by nasal obstruction, and pulmonary aspiration of nasal contents. Patients with chronic sinusitis commonly have nonspecific bronchial hyperresponsiveness, suggesting a neural reflex. Postnasal drainage of nasal inflammatory mediators during sleep also may increase lower airway responsiveness. Therapy of nasal and sinus disease is associated with improved pulmonary function in patients with COPD.
流行病学研究表明，多达75%的慢性阻塞性肺疾病（COPD）患者伴有鼻部症状，超过三分之一的鼻窦炎患者也有哮喘或COPD的下呼吸道症状。由于上、下呼吸道的炎症反应相似，且两个部位接触过敏原和刺激物的情况也相似，因此鼻炎或鼻窦炎与COPD共存并不奇怪。上、下呼吸道功能障碍合并存在的可能机制包括所谓的鼻-支气管反射、吸烟引起的炎症、鼻塞导致的口呼吸以及鼻腔分泌物的肺内吸入。慢性鼻窦炎患者通常有非特异性支气管高反应性，提示存在神经反射。睡眠期间鼻内炎症介质的鼻后滴流也可能增加下呼吸道反应性。鼻部和鼻窦疾病的治疗与COPD患者肺功能的改善相关。
