Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies

Abstract

The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.

Characterization of T2-Low and T2-High Asthma Phenotypes in Real-Life

“…Allergic asthma is usually characterized by early onset [ 38 ], whereas non-allergic and T2-low asthma is more frequently associated with obesity and old age [ 39 , 40 ]. This study confirmed the association between T2-high asthma and its severity [ 41 ], that could be explained by upper airways comorbidity [ 42 ].…”

Local Bacteriotherapy – a promising preventive tool in recurrent respiratory infections

“…Bacterial interference through Local Bacteriotherapy ma be envisaged a feasible, harmless, and reliable approach. Local administration of natural compounds represents an opportunity of directly modulating the immune response, which may be impaired by several environmental or individual factors [55]. The bacteriotherapy approach's rationale is the local persistence of safe bacteria, which competitively exclude or inhibit the growth of pathogens without unbalancing the existing ecosystem [56].…”

Pharmacologic Activities of Plant-Derived Natural Products on Respiratory Diseases and Inflammations

“…Number of trials had been conducted for treating upper airway disorders such as allergic rhinitis, nasal polyps, and chronic rhinosinusitis for which several therapeutics such as omalizumab, mepolizumab, dupilumab, a monoclonal antibody targeted toward IgE, an anti-IL-5 agent, anti-IL-4, and IL-3 had been used. The outcomes of the trials were positive [38]. Several other modern drugs have been discovered and synthesized in the laboratory with promising results.…”