Nasobronchial interaction in allergic rhinitis and asthma

The key to the diagnosis lies in taking a good medical history. This rule especially applies to allergic rhinitis and asthma. Both diseases have in common that they are often underdiagnosedl and lack proper treatment. Allergic rhinitis and asthma frequently occur together. Almost 40 % of the allergic rhinitis patients have lower airways involvement, whereas more than 80 % of the allergic asthma patients have concomitant rhinitis symptoms. The latter percentage gets close to 95 % when a careful nasal history is taken and physical examination is performed. Allergic asthma is characterized by a history of episodes of cough, dyspnea, shortness of breath, chest tightness and wheezing, in combination with variable bronchoconstriction and/or bronchial hyperresponsiveness (BRR). Mucosal inflammation is also considered an important hallmark of asthma6. However, the associations between mucosal inflammation and clinical parameters, such as variable airflow obstruction and BRR, are still controversia. Allergic rhinitis is primarily based on a typical history of sneezing, rhinorrhoea, eye symptoms and nasal obstruction. As in allergic asthma, the atopic status needs to be confirme<f4. In perennial rhinitis, chronic nasal obstruction can sometimes be the only symptom, which makes it difficult to confIrm the diagnosis. The diagnosis of seasonal allergic rhinitis is less disputable, the symptomatology and seasonal occurrence are characteristic and have been well established for many years. The distinction between allergic asthma and rhinitis is sometimes difficult to make since symptom perception is widely variable; lung function can be normal in mild asthmatics and, although BHR is a constant feature of asthma, it is also frequently present in allergic rhinitis.

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