Management of sinusitis in the asthmatic patient

Objective: To describe pathophysiologic links between sinusitis and asthma; to identify means of diagnosing sinusitis in the asthmatic; to discuss the management of asthmatic patients with sinusitis, both medical and surgical; to examine the outcome of managing the asthmatic patient with sinusitis. Data Sources: Prospective and retrospective data from the author's experience was evaluated. Medline database was searched from January 1, 1984, using the keywords ''asthma'' and ''sinusitis'' without restriction to species or language; 48 articles identified. Relevant articles referenced in retrieved sources, current texts in otorhinolaryngology and sinus disease were also utilized. Study Selection: From data source abstracts, pertinent articles (33) and book chapters meeting the objectives of our paper were intensively reviewed. Results: Clinical and experimental studies indicate that sinonasal inflammation can result in worsening of lower airway disease, while the exact nature of this relationship remains debated. Regardless of mechanism, identification of the asthmatic patient with chronic sinusitis using the techniques of nasal endoscopy and CT scanning can lead to treatment of sinusitis with overall sinus and asthmatic disease improvement. Proper management is first medical, while surgical approaches are reserved for persistent cases. Traditional, more radical, surgical approaches have shown good results overall, while newer techniques of functional endoscopic sinus surgery which respect anatomy and mucosal function are less studied but expected to result in similar or better long-term outcome. Conclusions: Sinusitis and asthma coexist and impact on one another at many different levels. Proper identification of the asthmatic patient with chronic sinusitis can be readily discerned by an accurate and thorough history and physical examination including nasal endoscopy and CT scanning. Proper medical and surgical management of sinusitis in the asthmatic patient can result in both improved sinonasal and asthmatic symptoms with fewer physician visits and decreased need for medication.