Nasal and sinus inflammation in chronic obstructive pulmonary disease

Area of Science:

• Respiratory Medicine
• Otolaryngology
• Immunology

Background:

• High comorbidity between chronic obstructive pulmonary disease (COPD) and upper airway diseases like rhinitis and sinusitis is frequently observed.
• Similar inflammatory pathways and shared exposure to environmental irritants in upper and lower airways contribute to their frequent coexistence.

Purpose of the Study:

• To explore the relationship between upper airway conditions (rhinitis, sinusitis) and lower airway diseases (asthma, COPD).
• To investigate potential mechanisms linking upper and lower airway dysfunction.
• To assess the impact of treating nasal and sinus disease on COPD pulmonary function.

Main Methods:

• Review of epidemiologic studies on the prevalence of concomitant upper and lower airway symptoms.
• Discussion of proposed pathophysiological mechanisms, including nasal-bronchial reflex, smoking-induced inflammation, and aspiration.
• Analysis of studies evaluating the effect of nasal/sinus therapy on COPD outcomes.

Main Results:

• Up to 75% of COPD patients report nasal symptoms; over 33% of sinusitis patients have asthma or COPD symptoms.
• Mechanisms include nasal-bronchial reflex, smoking, mouth breathing, and aspiration of nasal contents.
• Nonspecific bronchial hyperresponsiveness is common in chronic sinusitis, suggesting neural reflexes.

Conclusions:

• Upper and lower airway inflammation are closely linked, with rhinitis/sinusitis frequently coexisting with COPD.
• Therapeutic interventions targeting nasal and sinus disease show potential for improving pulmonary function in COPD patients.