No abstract

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.

Background Atopic bronchial asthma (BA) in children is associated with upper airways pathology (UAP). Among them, a combination of allergic rhinitis (AR) and nasal obstructive disorders (NOD), including hypertrophy of the pharyngeal tonsil (HPT) and anomalies of the intranasal structures (AINS), is abundant. In such patients, anterior active rhinomanometry (AARM) is an important method of examining nasal patency. However, NOD can influence the AARM parameters in children with BA and nasal symptoms, and this effect must be taken into account in clinical practice. Study goal was to elucidate the effect of NOD on rhinomanometric parameters in this group of patients. MethodsTotal of 66 children with BA and AR were examined with AARM, rhinovideoendoscopy, spirometry, and standard clinical tests allowing revealing the structure of comorbid pathologies. In order to avoid the influence of anthropometric parameters of children and their age on AARM parameters, a special index of reduced total nasal airflow was used. ResultsIt has been established that NOD, especially HPT, have a significant negative impact on the indices of anterior active rhinomanometry during the periods of both AR remission and AR exacerbation. The effect of AINS is much weaker and was remarkable only in combination with HPT.

Bronchial asthma (BA) is often associated with chronic inflammatory processes in the nasal mucosa; these processes give rise to allergic rhinitis, chronic rhinosinusitis, adenoiditis, and polypous rhinosinusitis. Due to their multiple symptoms, these diseases of the upper respiratory tract, especially allergic rhinitis, are often difficult to verify in patients with asthma. The aim of the study was to evaluate the diagnostic potential of endonasal IR thermometry in BA patients suspected of allergic rhinitis. Materials and Methods. Fifty children diagnosed with both BA and allergic rhinitis and 15 healthy children, matched by gender and age, participated in the study. The endonasal temperature determined with contactless IR thermometry was confronted with the symptoms of allergic rhinitis and sinusitis assessed with the TNSS and SNOT-20 questionnaires. The results were compared with the severity of nasal obstruction as determined through the anterior active rhinomanometry. Results. The nasal temperature in patients with asthma and allergic rhinitis was 33.77 [33.37; 34.17]°С, which was significantly lower than that in the group of healthy children (34.98 [34.57; 35.39]°С; p=0.0006); the body temperature did not differ between the groups (36.55 [36.45; 36.65] and 36.58 [36.40; 36.76]°С, respectively; p=0.5). We found a negative correlation between the values of nasal temperature and the sinusitis symptom scores in patients with BA and allergic rhinitis (R=-0.32; p=0.02). Conclusion. Patients with both BA and allergic rhinitis showed a decreased endonasal temperature in comparison with healthy children; the endonasal temperature can serve an indicator of allergic inflammation of the nasal mucosa.

Bronchial asthma is associated with upper airway (UA) disorders, primarily with allergic rhinitis, which, in turn, occurs in combination with other UA conditions, including hyperplasia of the nasal mucosa. Chronic rhinosinusitis, if confirmed, is a predictor of asthma severity. The pathogenesis of these diseases includes the remodeling (restructuring) of the extracellular matrix and the adjacent UA structures, which is associated with further worsening of the diseases and their resistance to therapy. It is known that remodeling of the lower respiratory tract in bronchial asthma is characterized by epithelial desquamation, hyperplasia of goblet cells, thickening of the basement membrane, fibrosis of the subepithelium, hyperplasia of smooth muscles of the respiratory tract, and increased angiogenesis. At the same time, the UA remodeling in patients with asthma is still poorly understood; the data are still limited and often contradict each other. With isolated allergic rhinitis, the remodeling process is not very much pronounced and is limited, apparently, to a basement membrane thickening. In chronic rhinosinusitis, the UA remodeling manifests by epithelial hyperplasia and an increased sedimentation and degradation of the matrix along with the accumulation of plasma proteins. Despite recent extensive studies, the cellular and molecular mechanisms involved in the respiratory tract remodeling remain largely undetermined, which necessitates further research into these processes. The review addresses several aspects of neuro-humoral control of the extracellular matrix metabolism and the associated remodeling of the upper and lower airway in patients with asthma.