Janus looks both ways: How do the upper and lower airways interact?

Area of Science:

• Respiratory Medicine
• Allergy and Immunology
• Pediatric Pulmonology

Background:

• Epidemiologic and pharmacologic studies reveal a strong connection between upper and lower airway diseases.
• Rhinitis, rhinosinusitis, and asthma are increasingly viewed as manifestations of a single inflammatory process affecting different airway sites.
• Eosinophils play a central role in allergic diathesis and airway inflammation.

Purpose of the Study:

• To explore the interconnectedness of upper and lower airway diseases.
• To highlight the diagnostic and therapeutic implications of this airway relationship.
• To examine the overlap and association between childhood sleep disordered breathing (SDB) and asthma.

Main Methods:

• Review of existing epidemiologic and pharmacologic studies.
• Analysis of scientific evidence supporting a common inflammatory pathway.
• Evaluation of symptomatology and pathophysiology overlap between SDB and asthma in children.

Main Results:

• A consistent body of evidence supports a unified inflammatory concept for upper and lower airway diseases.
• Significant overlap in symptoms and pathophysiology exists between childhood SDB and asthma.
• Causality between SDB and asthma is not yet established, but association is evident.

Conclusions:

• Recognizing the interplay between upper and lower airways is crucial for diagnosis and treatment.
• Children with poorly controlled asthma should be evaluated for SDB, as it can increase morbidity.
• Children with SDB should be considered for asthma evaluation.
• Further longitudinal research with objective measures is needed to clarify the association between these conditions in children.