Addressing Upper Airway Comorbidities: A Key Strategy in Asthma Management

Asthma is not a singular condition but a chronic, heterogeneous airway disease often accompanied by various comorbidities. Over two decades ago, the term "one airway, one disease" was introduced to highlight the link between asthma and upper airway conditions.

Types of Upper Airway Comorbidities:

- Allergic Rhinitis

- Non-Allergic Rhinitis

- Mixed Rhinitis

- Chronic Sinusitis (with or without nasal polyps)

- Aspirin or Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Impact of Upper Airway Comorbidities on Asthma:

Upper airway conditions can exacerbate asthma by increasing airway inflammation and reactivity, thus worsening symptoms and potentially leading to more severe asthma attacks.

Improving Asthma Through Treatment of Upper Airway Comorbidities

Local Treatment Options:

Intranasal Steroids and Antihistamines: These can significantly improve asthma symptoms, enhance pulmonary function, reduce bronchial hypersensitivity, and decrease the need for rescue medications.

Systemic Treatment Strategies:

In terms of systemic treatments of upper airway comorbidities, we have several options:

1. Allergen avoidance.

2. Oral antihistamines.

3. Antileukotriene agents, such as Montelukast.

4. Allergen immunotherapy.

5. Biologics such as omalizumab.

Allergen Avoidance:  Critical for reducing symptoms, especially in conditions like occupational asthma.

Oral Antihistamines: While they may help with asthma symptoms, they are not primary treatments but can aid in reducing bronchial hyperresponsiveness.

Antileukotriene Agents (e.g., Montelukast): Though less commonly used for upper airway issues alone, these agents can enhance asthma control and lower medication use for rescue.

Allergen Immunotherapy: Recognized for its efficacy in improving asthma symptoms, potentially lowering asthma development risk, and reducing bronchial hyperresponsiveness.

Biologics (e.g., Omalizumab, Dupilumab): While omalizumab is seldom used solely for upper airway issues, Dupilumab is approved for chronic sinusitis with nasal polyps. These treatments can improve asthma symptoms, quality of life, and decrease exacerbation frequency.