Rhinobronchial syndrome: pathogenesis and correlation with allergic rhinitis in children

In the rhinobronchial syndrome a direct causal relationship exists between local nasal irritation and bronchopulmonary disease. Although allergic rhinitis has often been associated with lower airway hyperresponsiveness, no direct relationship between the two has been shown to date. The aim of this study was to determine the role of allergic rhinitis in the pathogenesis of the rhinobronchial syndrome in children by evaluating the effect of topical nasal treatment on lower airway hyperresponsiveness.

A total of 168 children presenting with aeroallergy and nasal disease associated with bronchopulmonary disease (asthma, chronic cough, bronchopulmonary infection) were evaluated at baseline and at 1 year of follow-up. Nearly half (83) were noted to have signs of allergic rhinitis and were treated with topical nasal medications (cortisones and antihistamines). Changes in upper and lower airway diseases were evaluated and potential causal relationships established.

Allergic rhinitis treatment improved nasal disease symptoms in 67 (80.7%) patients; partial remission or lower healing rates were found in those with asthma (16.4%) and chronic cough (11.1%).

Although often associated with lower airway hyperresponsiveness, allergic rhinitis in children does not appear to be a pathogenetic factor, as confirmed by the scarce effect the nasal treatment had on the bronchopulmonary disease. Instead, the frequent co-existence of nasal and bronchial symptoms may come under the concept of global allergy of the airways.