Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
Int J Mol Sci. 2024 Jan 5;25(2):730. doi: 10.3390/ijms25020730.
Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.
慢性鼻-鼻窦炎（CRS）最近经历了重大的范式转变，从表型分类转向基于“表型分类”的定义，更加注重临床和治疗方面。与哮喘等其他气道疾病类似，大多数发达国家的 CRS 病例表现出失调的 2 型免疫反应和相关细胞因子。因此，传统的上、下气道的区分已被“联合气道”的观点所取代。此外，2 型相关疾病不仅限于呼吸道，还包括气道以外的疾病，如特应性皮炎。这需要多学科的方法。此外，必须考虑可能的全身影响，特别是与睡眠相关的呼吸疾病，如阻塞性睡眠呼吸暂停综合征（OSAS）和全身炎症介质如一氧化氮的改变。全球流行病学、经济和社会负担的趋势正在逐步增加，表明存在综合征特征。有鉴于此，本叙述性综述旨在介绍最新的与呼吸道 2 型相关疾病的证据，特别关注 CRS，同时促进对“联合气道”的全面认识。它还引入了一个新概念：将这些疾病视为一种多器官、全身性和综合征性疾病。
