Asthma and its link to nose and sinus problems

Let me be very controversial here.  There’s no such thing as asthma.  I’ll re-phrase that.  There is a condition still called asthma but now better incorporated into the term United Airways’ Disease (and no, that’s not a low fares airline ailment!).  United Airways’ Disease implies that asthma is but the lung component of a much more complicated condition that involves the nose, sinuses, lungs and blood stream.

Case history: a 33 year old publishing editor had an intractable cough.  She also had asthma and was using standard full strength anti-asthma therapy.  The cough was socially embarrassing and spoiled her quality of life.  Any type of conversation was cut short by a bout of convulsive spluttering.  She attended two GPs in the same London practice and the respiratory unit of a top London teaching hospital.  There she was reviewed by three specialists (one a pulmonary allergist), had multiple tests including chest X-ray, pulmonary function tests and allergy tests.  She showed very large responses to dust mites, pollens and cat hair.  She was given a fact sheet on dust mites and de-cluttered her apartment to little more than bare boards and a wooden bed.  Her cough continued.  The hospital advised nothing else could be done and suggested to her GP that this was possibly a psychological cough and recommended a mild tranquilliser.  In desperation (and convinced it was not a psychological cough) she sought help elsewhere.  

During questioning at a reputable private allergy clinic she agreed that her nose was blocked all the time, that her senses of taste and smell were poor and that her hearing was down (“I have had to turn up the volume on my IPod recently.”).  When examined she was found to have severe swelling of her nose lining with fluid blistering of the turbinates (the shelves along the nose, check back to Chapter 3 for a detailed explanation).  “You’re the first doctor to have inspected my nose,” she remarked.  There was fluid behind both ear drums suggesting Eustachian tube obstruction (again, see Chapter 3 for explanation).  Further questioning revealed she worked in a smoky office (the non-smoking ban hadn’t come into effect in the UK in small offices) and that the owner had a large cat that shed hair.

It was explained that the cough was almost certainly due to her aggressive, un-recognised and un-treated nose and sinus allergy.  It was suggested that while her home environment might be perfect, her workplace was a definite health hazard.  She was treated appropriately and the nasal cavity stabilised.  To say her life changed for the better is an understatement: symptom scores for her sinusitis symptoms and asthma dropped by 80%.  The cough flared at work and in smoky environments so she quit her job and found a better (and safer) office.  Now she is enjoying a dramatically improved lifestyle.  Her hearing has improved as well.  However she’s quite annoyed with the NHS and that top London teaching hospital (not to mention her smoking colleagues and the boss’s cat).

Here are a few facts: 

  • Almost all asthma, especially allergic asthma, involves the nose and sinuses.
  • Allergic nose and sinus problems are the trigger to asthma.
  • Coexistent allergic nose and sinus allergy in asthmatic children causes more asthma-related hospital admissions and greater total days spent in hospital

The relationship between allergic nose/sinus problems and asthma has been known about for some time and patients commonly present with both disorders.  Experts believe allergic sinusitis and asthma are connected by a number of different pathways.  For example, post nasal drip may contain cells that slip into the lungs and trigger asthma-type symptoms.  Also, special blood units (called Th2) move from the nose and sinuses to the bone marrow to produce a number of allergy groupings.  They then transfer into the blood circulation and ‘stick’ in the nose, sinuses and lungs, causing further allergic inflammation (swelling and irritability of the tissues involved).  I appreciate this is all very complicated and medical (and to be honest, I’m not sure I understand the half of it myself, but do recognise the sense behind the theory).  The bottom line is this: treat the affected nose and sinuses and you improve any co-existing asthma significantly.

All children with true asthma have some type of nose/sinus problems, usually allergy-driven.  When allergic sinusitis is very active, airway irritability increases, often aggravating the symptoms of asthma.  Furthermore, the onset of allergic sinusitis sometimes precedes asthma and the onset of asthma may be prevented by successful treatment of allergic sinusitis.

Significant problems in the upper airways (i.e., the nose and sinuses) can produce symptoms in the lower respiratory tract (i.e., the lungs).  Treat the upper respiratory problems and you can alleviate or even cure the lower respiratory trouble.

Case history: Patrick is 7-year-old with troublesome asthma.  He’s seen many doctors, including asthma specialists and is on a lot of anti-asthma medication.  But he’s still troubled with his chest and each breakdown in well-being seems to start with a head cold.  There is a strong history of allergy in the family (two sisters had eczema as babies, his father sufferers hay fever each summer) but no attention is paid to Patrick’s parents’ request for allergy testing (‘waste of time, could be anything, try lifting the carpets,’ are the dismissive comments).  Each doctor advised that the boy had difficult asthma made worse by repeated virus infections.  Live with it, they said.  Stop annoying us, they didn’t say but implied.

When Patrick was evaluated at a reputable allergy centre a completely different interpretation was put on his ill-health and its management.  The examining doctor inspected the inside lining of Patrick’s nose (‘no other doctor has ever done that’, commented Patrick’s mother). It was obvious Patrick had a severe nose and sinus allergy (swollen, pale and blistered nose lining, dramatic ‘allergy-attack’ features at the highest point of his nose).  He was wheezing loudly despite taking his prescribed anti-asthma therapy.

Allergy testing revealed strong positives to dust mites and cat hair (the family had a pet cat and it often slept on Patrick’s bed).  

His new management included an aggressive anti-allergy regime that restored his nasal mucosa to normal.  Because Patrick had both nose and sinus and lung allergic challenges he was prescribed a special anti-allergy drug.  For the first time in years Patrick’s quality of life improved.  He showed a dramatic recovery in his chest as his nose and sinus problems came under control.  After about four weeks his asthma medication was reduced by as much as 80%.  

Patrick now has excellent asthma control with less drugs being used.  And he feels much more comfortable in his ‘head’, now that his nose is unblocked and his sinuses function properly.

What can we conclude from this?  Patrick’s upper airways’ allergy (nose/sinus area) was impacting on his lower airways (lungs, causing asthma).  Once identified and treated, Patrick’s out-of-control allergic sinusitis changed the boy’s life forever.  And his parents weren’t half pleased too.

It is now recognised internationally that asthma is but one component of a more complex and complicated inter-reaction of nose/sinus problems and the lungs.