Rhinitis and asthma connection: Management of coexisting upper airway allergic diseases and asthma

Asthma is a chronic inflammatory disease of the lower airways. Epidemiologi c surveys and clinical reports have documented that allergic rhinitis coexi sts with asthma in many patients. Provocative bronchial challenge with alle rgens responsible for allergic rhinitis in susceptible asthma patients can elicit asthma, and these responses have been linked to bronchial airway hyp erreactivity. Provocative bronchial methacholine challenge in allergic rhin itis patients will demonstrate increased airway responsiveness to the bronc hial challenge in 30% of those allergic rhinitis patients who had no past h istory of asthma. These data suggest that subclinical asthma may be present in certain patients with allergic rhinitis. The focus of the National Hear t, Lung, and Blood Institute (NHLBI) guidelines for the pharmacologic treat ment of asthma focuses on medications to relieve the symptoms of asthma, i. e., bronchodilators and anti-inflammatory agents (i.e., inhaled corticoster oids, cromolyn, and leukotriene modifiers) to control asthma. Avoidance of allergens such as house dust mite are also recommended. Although not emphas ized in these NHLBI guidelines, recent studies have observed that treatment s, including intranasal steroid, cromolyn, antihistamines, and decongestant s, which provide relief of nasal symptoms in patients with both allergic rh initis and asthma, will also improve the pulmonary symptoms of allergic ast hma. This article will review the recent literature.