Current opinions for the management of asthma associated with ear, nose and throat comorbidities

Abstract

Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are “treatable traits” in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.

What are the effects of rhinitis on patients with asthma?

“…Although evidence-based recommendations do not indicate the anti-leukotrienes as monotherapy for AR, literature findings showed an improvement both of nasal and bronchial symptoms as well as reduction of rescue medication use [13,15].…”

“…Although the evidence for benefit of allergen avoidance in patients with AR and asthma are still inconclusive, this environmental measure could be considered as part of a more complete therapeutic approach to AR with asthma [13,15].…”

“…The use of antihistamines in the treatment of asthma could be justified by the evidence that increased serum histamine levels are detected during asthma attacks. Nevertheless, the current guidelines do not recommend H1-antihistamines for treating asthma [2,13,15]. In fact, although H1-antihistamine administration is significantly associated with an improvement in AR and asthma symptoms, pulmonary function testing failed to demonstrate a significant impact on the lung function [2,13,15].…”

“…In subjects with AR and asthma, intranasal corticosteroids, preventing the lower bronchial hyperresponsiveness, decrease disease severity, asthma symptom scores and rescue medication use as well as improve lung function [13,15].…”

“…Thus, several cellular, humoral, molecular mediators have been investigated to identify potential biomarkers that, reflecting the inflammatory status common to AR and asthma, may allow to predict and monitor the severity and clinical course of united airway diseases. Nevertheless, the management and treatment of united airway diseases are commonly applied in an undesirable and independent manner, counteracting the concept of unified 2017 Extensive review focusing on upper airway pathology as the main comorbity of severe asthma Adults Children [5] 2017 Review of evidence supporting the hypothesis of United Airway as a single entity Pediatric [8] 2017 European position paper on biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinitis and allergic asthma Children Adults [12] 2018 Extensive review of current evidence and clinical evaluation of treatable traits in difficult asthma Adults [4] 2018 Review of management of asthma associated with ear, nose and throat comorbidities Children Adults [13] 2018 Consensus Statement on allergic rhinitis Children Adults [15] 2018 Updated review on the clinical indications of allergen immunotherapy, with particular reference to pediatric asthma Pediatric [16] a ref. : reference airways.…”