Dixon Anne E
Vermont Lung Center, Department of Medicine, University of Vermont, Burlington, Vermont 05405, USA.
Curr Opin Pulm Med. 2009 Jan;15(1):19-24. doi: 10.1097/MCP.0b013e32831da87e.
Disease of the nose and sinuses is the most common comorbidity associated with asthma. Rhinitis, sinusitis and asthma may represent part of one disease process with manifestations at different sites. The purpose of this review is to highlight significant new findings on the epidemiological and pathophysiological link between the upper and lower airway. Finally, we will review recent data assessing the impact of treating sinonasal disease on both the development of asthma and asthma control.
Studies illustrate that rhinitis is very common in asthma, and associated with worse asthma control. Rhinitis typically precedes the development of asthma. Even in patients with rhinitis without asthma, there is evidence of subclinical change in the lower airways as measured by physiological changes and the presence of inflammatory mediators. There is much interest on the impact of treating allergic rhinitis on the development of asthma.
Rhinitis, sinusitis and asthma are likely part of one disease process. Treatment of established rhinitis may have some impact on measures of airway obstruction, but an effect on lower airway inflammation is yet to be established. Prospective studies are required to determine whether treatment of rhinitis can prevent the development of asthma, or decrease airway inflammation to improve asthma outcomes in those with established asthma or both.
鼻和鼻窦疾病是与哮喘相关的最常见合并症。鼻炎、鼻窦炎和哮喘可能是同一疾病过程的一部分，只是在不同部位表现出来。本综述的目的是强调上、下气道之间流行病学和病理生理学联系的重要新发现。最后，我们将回顾近期评估治疗鼻鼻窦疾病对哮喘发生发展及哮喘控制影响的数据。
研究表明鼻炎在哮喘患者中非常常见，且与哮喘控制不佳相关。鼻炎通常先于哮喘出现。即使在无哮喘的鼻炎患者中，通过生理变化和炎症介质的存在也有证据表明下气道存在亚临床改变。治疗变应性鼻炎对哮喘发生发展的影响备受关注。
鼻炎、鼻窦炎和哮喘可能是同一疾病过程的一部分。治疗已确诊的鼻炎可能对气道阻塞指标有一定影响，但对下气道炎症的影响尚未明确。需要进行前瞻性研究以确定治疗鼻炎是否能预防哮喘的发生，或减轻气道炎症以改善已确诊哮喘患者的哮喘结局，或两者皆有。
