Management of adult asthma and chronic rhinitis as one airway disease

ABSTRACT

Introduction: Chronic rhinitis is defined as nasal inflammation with the presence of minimum two symptoms such as nasal obstruction, rhinorrhea, sneezing and/or itching one hour daily for a minimum of 12 weeks/year. According their etiology, four groups of rhinitis are described: allergic, infectious, non-allergic non-infectious and mixed.

Chronic rhinitis is frequently associated with asthma, shares similar mechanisms of the pathogenesis and has a negative impact of its outcomes sustaining the concept of unified airways disease.

Areas covered: The present review summarizes the complex relationship between chronic rhinitis and asthma on the basis of recent epidemiological data, clinical characteristics, diagnosis and therapeutic management. All four groups are discussed with the impact of their specific treatment on asthma outcomes. Some medications are common for chronic rhinitis and asthma while others are more specific but able to treat the associated comorbidity.

Expert opinion: The systematic assessment of chronic rhinitis in patients with asthma and its specific treatment improves both disease outcomes. Conversely, several therapies of asthma demonstrated beneficial effects on chronic rhinitis. Treating both diseases at the same time by only one medication is an interesting option to explore in the future in order to limit drugs administration, related costs and side effects.

KEYWORDS:

• Asthma
• chronic rhinitis
• management
• outcomes
• systematic assessment
• treatment

Acknowledgments

The authors would like to thank the Interasma European Scientific network (INES).

Article highlights

• Upper and lower airway have structural and functional similarities, so chronic rhinitis and asthma should be treated according to the concept ‘one airway, one disease’.

• More evidence exists for allergic and infectious rhinitis and their impact on asthma.

• When associated with asthma, chronic rhinitis induces poor asthma outcomes.

• Several of chronic rhinitis medications have showed a benefit on asthma outcomes and vice versa.

• Treating chronic rhinitis and asthma according to the concept of unified airways disease is an interesting option that could limit drugs administration, healthcare-related costs and side effects.

Declaration of interest

JC de Sousa has received personal fees, non-financial other support from Boehringer Ingelheim, GSK, and AstraZeneca, and is Advisory Board member for Mundipharma, Bial, Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.