Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

Abstract

The large amount of evidence and the renewed interest on upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma excecutive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change.UAD refer to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan.The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and homebased continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD.Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.

Association of rhinitis with asthma prevalence and severity

“…Another aspect to consider is the concept of ‘united airway diseases (UAD), as such that the upper airway and the lower airway form a single organ, and the symptomatology would be a reflection of the same underlying process with some clinical, epidemiological, and pathophysiological differences 37 . Some mechanisms have been established that appear to support the pathophysiological interactions between the upper and lower airway, by conditioning the air that we breathe, common inflammatory processes and neural reflexes.…”

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

“…5 Moreover, there is increasing evidence that the UAD concept also applies to other chronic diseases of the respiratory tract, such as COPD, bronchiectasis, cystic fibrosis, and nasal polyps. 6 For COPD, the reported prevalence of sinonasal symptoms is 40-88% [7][8][9][10] and the prevalence of rhinosinusitis without nasal polyps (RSsNP) is 3-fold greater than in controls. 11 Associations with upper airway symptoms, 8,10,12,13 rhinitis 14 and chronic rhinosinusitis with and without nasal polyps have been observed, 11,15,16 and the latter is associated with poorer HRQoL.…”

Diagnosis and Management of Allergic Rhinitis in Asthmatic Children

“…UAD includes rhinitis, chronic rhinosinusitis (CSR), nasal polyposis (NP), and concomitant/comorbid lower airways disorders: asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), and obstructive sleep apnoea (OSA). 11 Under the epidemiological perspective, the cross-relationship between allergic rhinitis and asthma is clear-cut. As mentioned above, approximately 80% of asthma patients suffer from rhinitis, and 30% of patients with rhinitis have asthma.…”

“…10 Respiratory comorbidities are common in these patients due to the shared immunological pathogenesis as well as to the physical and biological link between upper and lower airways, synthesized in the concept on United Airway Disease, as discussed below. 11 Sleep disturbances are frequent in both children and adults. Nasal congestion is the most common and bothersome symptom of rhinitis and is considered a major cause of sleep impairment in affected individuals.…”