Upper airway. 3: Sinonasal involvement in chronic obstructive pulmonary disease

Abstract

This review presents the evidence that chronic obstructive pulmonary disease (COPD) is associated with significant sinonasal symptoms, inflammation and airway obstruction. Upper airway symptoms in COPD cause impairment to quality of life. The severity of upper airway involvement relates to that present in the lower airway, suggesting that the nose may be used to model the lung in COPD. More importantly, relationships between upper and lower airway bacteria and inflammation, and the association between sinusitis and treatment failure at exacerbation raise the possibility that nasal intervention in COPD may not only improve health status but may also affect important clinical outcomes such as exacerbation frequency.

Factors associated with misdiagnosis of COPD in primary care

“…An increased prevalence of nasal inflammation has been described in biopsy and lavage studies of patients with COPD 40,41 compared with never-smokers and ex-smokers, but the cause of this relationship -whether it is independent, co-existent, or in some way a confounder on the making of the diagnosis -remains unclear. 41 Similar to the finding in our study, an association was found in Canadian family practices between an increase in the number of respiratory symptoms (cough, breathlessness, wheeze, phlegm, and colds) and decreasing misclassification of COPD (OR 0.29, p=0.045), but no associations were found for age (p=0.99), gender (p=0.25), current smoking status (p=0.56), or increasing number of respiratory-related visits to a primary care physician (p=0.37). 33 The relationship between misclassification and obesity we found -which was also seen in an open access spirometry service in the UK 42 -is plausible since obesity causes breathlessness on exercise, 43 affecting exercise performance due to the higher metabolic demand at any given power output as a result of an increased oxygen cost.…”

Is the sinonasal questionnaire a useful screening instrument for chronic sinonasal diseases in pulmonary clinics?

“…6 We could not identify studies that compared outcomes in patients with chronic lung diseases who are appropriately diagnosed and treated for upper airway symptoms. Our pilot study demonstrates that a simple screening tool for chronic sinonasal disease is useful in pulmonary clinics.…”

“…These associations have led to the suggestion that upper and lower airway symptoms represent a single airway disease. [6][7][8][9] Possible mechanisms for the association between the upper and lower airways in COPD include impaired nasal conditioning and filtering, neural interactions between the upper and lower airways, called nasobronchial neuronal reflexes, aspiration of nasal secretion, systemic propagation of nasal inflammation to the bronchial mucosa, and concomitant systemic inflammation with airway inflammation. 6,9,10 Hurst and coworker reported that the upper airway symptoms are more frequent in patients with confirmed COPD and that these symptoms reduced their quality of life.…”

“…5 These epidemiologic and clinical studies suggest that there is an association between upper and lower airway diseases, often called the ''united airway'' hypothesis. [6][7][8][9] However, concomitant upper airway symptoms or sinonasal disease is often underdiagnosed and undertreated in patients with lower airway diseases, and it is possible that treating upper airway diseases in these patients will improve their lower airway symptoms.…”

Diagnosis of Chronic Obstructive Pulmonary Disease with Special Reference to Over- and Underdiagnosis Using Spirometry

“…In addition, a recent epidemiological study suggests that certain nasal features may be associated with COPD (Hurst, 2010;Montnemery et al, 2008).…”