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Pediatric rhinosinusitis and asthma
Dimitri Poddighe1, Ilaria Brambilla2, Amelia Licari2
1Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan; Department of Pediatrics, Università Degli Studi, Pavia, Italy.
Insights
Pediatric asthma and rhinosinusitis frequently coexist, impacting 35-65% of children. This review explores the shared pathophysiology, revealing how upper airway inflammation can systemically amplify lower airway eosinophilic responses.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Otolaryngology
Background:
- Asthma and rhinosinusitis are complex, heterogeneous diseases frequently co-occurring in children.
- This comorbidity affects an estimated 35-65% of pediatric patients, necessitating clinical attention.
- Understanding the link between upper and lower airway diseases is crucial for effective management.
Purpose of the Study:
- To review the pathophysiological mechanisms linking rhinosinusitis and asthma in children.
- To elucidate the complex interplay between upper and lower airway inflammation.
- To highlight the systemic amplification of eosinophilic inflammation.
Main Methods:
- Literature review focusing on pediatric studies.
- Analysis of pathophysiological pathways connecting rhinosinusitis and asthma.
- Examination of inflammatory processes, including cytokine release and bone marrow stimulation.
Main Results:
- Rhinosinusitis can exacerbate asthma via contiguous mechanisms.
- A persistent Th2-driven, eosinophilic inflammatory process in one airway site can trigger systemic effects.
- Cytokines released into the bloodstream stimulate bone marrow, amplifying eosinophilic inflammation.
Conclusions:
- The comorbidity of asthma and rhinosinusitis involves a complex interplay beyond simple contiguity.
- Systemic amplification of eosinophilic inflammation, originating from upper airway disease, plays a significant role.
- Further research into this systemic link is paramount for pediatric respiratory health.
Abstract:
Both asthma and rhinosinusitis are complex and heterogeneous diseases and, importantly, they often coexist: these diseases can be concomitant in 35-65% of affected children, according to different studies. Thus, evaluating this comorbidity in the clinical practice should be paramount. In this review, we focused our discussion on the multiple pathophysiological aspects that may link rhinosinusitis and asthma in the pediatric population. Although rhinosinusitis may exacerbate asthma through several mechanisms occurring by contiguity, actually this aspect seems to be only one component of the complex interplay between upper and lower airways. In particular, the onset of an important and persistent Th2-driven inflammatory process dominated by eosinophils presence at one site of the airways, may release into the bloodstream several cytokines; in their turn, those can lead to the stimulation of the bone marrow, which may function as a systemic amplifier of such an eosinophilic inflammation.
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