Bradley F. Marple, MD, is Professor and Vice-Chairman of the Department of Otolaryngology-Head and Neck Surgery at University of Texas Southwestern Medical Center in Dallas.
Explore this issue:August 2007
I have found that it is not uncommon during the course of an office visit for a patient to offer an opinion pertaining to the role that nasal troubles play in his or her general health. Specifically, these individuals point out the fact that exacerbations of their chronic rhinosinusitis or allergic rhinitis gives rise to a worsening of asthma symptoms, decreases in exercise tolerance, and need for more frequent use of rescue medications. The coexistence and seeming interdependence of these maladies resonate with the sufferers to the point that when asked, many patients will often happily describe their personal theory of the pathophysiology of this phenomenon. And even though in many instances the explanation may be a little off the scientific mark, I am generally impressed with the consistency of these observations from patient to patient. Truth be known, when the premise of this argument is subjected to current peer-reviewed medical literature, it appears that these patient observations are reasonably close to the current conventional wisdom as it relates to respiratory diseases.
Concept of the Unified Airway
Over the course of the past two decades, the concept of inflammation involving both the upper and lower airways has become increasingly recognized and studied. When examined, asthma, allergy, and rhinosinusitis appear to behave similarly and in conjunction with one another in many cases, suggestive of an integration of the involved areas of the airway. This pattern of similarities has given rise to the concept of the unified airway model, which, simply stated, considers the entire respiratory system to represent a functional unit that consists of the nose, paranasal sinuses, larynx, trachea, and distal lung.1 The broad number of inflammatory diseases that occur within this functional unit present to a variety of specialties, including otolaryngology, pulmonology, primary care, and allergy. Similarly, literature related to this concept is distributed among the literature of each of these specialties.