Upper and lower airway interactions in children

Area of Science:

• Pediatric respiratory medicine
• Immunology
• Otolaryngology

Background:

• Rhinitis, rhinosinusitis, and asthma frequently coexist in children, creating a complex clinical picture.
• The concept of united airway disease emphasizes the interconnectedness of upper and lower respiratory tract inflammation.
• Understanding the shared pathophysiology is crucial for effective management of these pediatric conditions.

Approach:

• This review synthesitsizes current scientific understanding of the interactions between upper and lower airway diseases in children.
• It examines recent advances in the pathophysiology, including the role of eosinophils and differences in sinonasal histopathology between pediatric and adult chronic rhinosinusitis.
• The review also discusses emerging therapeutic strategies.

Key Points:

• Eosinophils play a significant role in the inflammatory processes linking upper and lower airway diseases.
• Severity of sinonasal disease often parallels that of asthma in children.
• Pediatric chronic rhinosinusitis exhibits distinct histopathological features compared to adults.

Conclusions:

• Allergic rhinitis and rhinosinusitis are critical comorbidities in pediatric asthma.
• Advances in understanding inflammation and remodeling pave the way for novel therapeutic approaches.
• Personalized drug therapies hold promise for managing united airway disease in children.