Current controversies: Sinus disease and the lower airways

This review explores the literature dealing with the relation between the u pper and lower airways, including the possible link between chronic sinus d isease and asthma, and between chronic sinus disease and cough. Imaging stu dies, microbiology, epidemiology, animal studies, and effects of treatment are discussed. Available studies do not prove that upper airway disease directly causes lo wer airway pathology. Allergic rhinitis causing nasal blockage needs treatm ent, as does symptomatic sinus disease. Where there is concurrent disease o f the upper and lower airways, both conditions need to be treated adequatel y. Further research is required to establish the relation between upper and lo wer airways, and animal models may help to unravel the mechanisms and impac t of treatment. Randomized, blinded, controlled trials are needed in both c hildren and adults to assess therapies of chronic sinusitis and the respons e of asthma. Pediatr Pulmonol, 2001; 31:165-172. 2001 Wiley-Liss, Inc.