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

Asthma is a chronic inflammatory disease of the lower airways. Epidemiologic surveys and clinical reports have documented that allergic rhinitis coexists with asthma in many patients. Provocative bronchial challenge with allergens responsible for allergic rhinitis in susceptible asthma patients can elicit asthma, and these responses have been linked to bronchial airway hyperreactivity. Provocative bronchial methacholine challenge in allergic rhinitis patients will demonstrate increased airway responsiveness to the bronchial challenge in 30% of those allergic rhinitis patients who had no past history of asthma. These data suggest that subclinical asthma may be present in certain patients with allergic rhinitis. The focus of the National Heart, Lung, and Blood Institute (NHLBI) guidelines for the pharmacologic treatment of asthma focuses on medications to relieve the symptoms of asthma, i.e., bronchodilators and anti-inflammatory agents (i.e., inhaled corticosteroids, cromolyn, and leukotriene modifiers) to control asthma. Avoidance of allergens such as house dust mite are also recommended. Although not emphasized in these NHLBI guidelines, recent studies have observed that treatments, including intranasal steroid, cromolyn, antihistamines, and decongestants, which provide relief of nasal symptoms in patients with both allergic rhinitis and asthma, will also improve the pulmonary symptoms of allergic asthma. This article will review the recent literature.