MANAGEMENT OF SINUSITIS IN THE ASTHMATIC PATIENT

Objective: To describe pathophysiologic links between sinusitis and as thma; to identify means of diagnosing sinusitis in the asthmatic; to d iscuss the management of asthmatic patients with sinusitis, both medic al and surgical; to examine the outcome of managing the asthmatic pati ent with sinusitis. Data Sources: Prospective and retrospective data f rom the author's experience was evaluated. Medline database was search ed from January 1, 1984, using the keywords ''asthma'' and ''sinusitis '' without restriction to species or language; 48 articles identified. Relevant articles referenced in retrieved sources, current texts in o torhinolaryngology and sinus disease were also utilized. Study Selecti on: From data source abstracts, pertinent articles (33) and book chapt ers meeting the objectives of our paper were intensively reviewed. Res ults: Clinical and experimental studies indicate that sinonasal inflam mation can result in worsening of lower airway disease, while the exac t nature of this relationship remains debated. Regardless of mechanism , identification of the asthmatic patient with chronic sinusitis using the techniques of nasal endoscopy and CT scanning can lead to treatme nt of sinusitis with overall sinus and asthmatic disease improvement. Proper management is first medical, while surgical approaches are rese rved for persistent cases. Traditional, more radical, surgical approac hes have shown good results overall, while newer techniques of functio nal endoscopic sinus surgery which respect anatomy and mucosal functio n are less studied but expected to result in similar or better long-te rm outcome. Conclusions: Sinusitis and asthma coexist and impact on on e another at many different levels. Proper identification of the asthm atic patient with chronic sinusitis can be readily discerned by an acc urate and thorough history and physical examination including nasal en doscopy and CT scanning. Proper medical and surgical management of sin usitis in the asthmatic patient can result in both improved sinonasal and asthmatic symptoms with fewer physician visits and decreased need for medication.