Lectures-PPS-Sinusitis.pps

8/12/2019 Lectures-PPS-Sinusitis.pps

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BY Dr.KhaledHelmy

Rhinosinusitis

&Asthma

Al Maamora Chest Hospital


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Reflect the inflammatory process that extends from thesinuses to the nasal mucosa, causing symptoms of

nasal obstruction and nasal discharge both are the

prominent features of sinusitis.

Rhinosinusitis


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"The nose is the gatekeeper of the lung.

The link between rhinitis- sinusitis

and asthma has been recognied

since the second century !, when

#alen drew an association betweenthe large number of indi$iduals who

suffered from both wheeing and

nasal discharge.

pathophysiologic, and clinical

data confirmed the strong

comorbidity.
http://www.lindgrensmith.com/geras/index8.html


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%atients with allergic rhinitis and no clinical

e$idence of asthma fre&uently exhibit

bronchial hyperresponsi$eness to

bronchoconstrictor agents such as

methacholine or histamine.

'ronchial hyperreacti$ity may represent an

intermediate phase between nasal allergy and

symptomatic asthma.

!ppropriate treatment of allergic rhinitis

results in impro$ements in asthma symptoms

and lower airway function.

"The nose is the gatekeeper of the lung.


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100

50

100

88

0

20

40

60

80

100

!ll.Rhinitis (s !sthma

Asthma

All Rhinitis


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9399

0

50

100

incidence of !ll.Rhinitis in !topic asthma

All.Rh.adults

All.Rh.adolecent


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)ncidence of !llergic Rhinitis

in !llergic !sthma

25%

75%

*ithout !llergy *ith !llergy


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1.c

e

t

i

r

i

z

i

n

e

1.e

*hat is interrelationship of Rhinosinusitis

and asthma+

The uestions ++

*hat are the mechanisms of this

interrelationship +

*hat are the suggestions for optimaltreatment of both+


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becti$es

Toidentify the indicators of rhinosinusitis

and asthma.

To understand the $arious pathophysiologic

mechanisms responsible for the concomitant

occurrence of rhinosinusitis and asthma.

To recognie the importance of identification and treatment of upper airway disease in

management of chronic asthma .


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!natomy of the /inuses

The sinuses ha$e small orifices 0ostia1 that open into recesses in the nasal ca$ities called meati.

The meati are co$ered by the turbinates 0also called

conchae1 which consist of bony shel$es surrounded

by erectile soft tissue


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2unctions of the paranasal sinuses

!ir conditioning.

%ressure damping.

Reduction of skull weight.

3eat insulatio .

2lotation of skull in water.

)ncreasing the olfactory area.

(ocal resonance and diminution

of auditory feedback. 4itric xide

4itric xide secretion.


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Rhinosinusitis and asthma are characteried by an

inflammatory process that is marked histologically

by tissue eosinophils, mast cells, T lymphocytes ,

macrophages, and epithelial cells .

5ellular pathway


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%ulmonary aspiration

of nasal contents

3umoral pathway

when methacholine administered

into the nose of rabbits causes acute

bronchial hyperresponsi$eness,

*hich completely blocked if nose

pretreated with phenylephrine

The upper airway inflammation

probably augments nonspecific

bronchial responsi$eness

by mean of aspiration of nasal

discharge.


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/ame airway6/ame disease

Rhinitis and asthma are twomanifestations of allergicrespiratory disease.

%athogenic e$ents are triggered by exposure to

aeroallergens.

The histology of these diseases shows chronic,

eosinophilic inflammation .

Rhinitis and asthma represent globalallergic in$ol$ement of the airways.


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7outh breathing is associated

with nasal obstruction resultingin worsening of exercise-

induced bronchospasm,

whereas exclusi$e nasal

breathing significantly reduced

asthma after exercise.

)mpro$ements in asthma

associated with nasal

breathing may be the result of

superior humidification and

warmingof inspired air before

it reaches the lower airways.

7outh 'reathing

X


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/ince the second century !#alen was

obser$ed that purging nasal secretions

offered relief to persons with pulmonary

disease.

)n 8989, /luder hypothesied the

existence of a sinopulmonary reflex

thought to be responsible for that

phenomenon.

)n 89:;, the 2rench physiologist


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)n 89=9,


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!ll these studies suggest the presence

of a reflexin$ol$ing irritant receptors in

the upper airway and cholinergic ner$es

in the lower airway ie .4eural pathway.

4asal - bronchial reflex

/inopulmonary reflex

Receptors in the nose and pharynx and,

paranasal sinuses produce afferent fibers

that form part of the trigeminal ner$e,

which passes to the brain stem and connects with the

reticular formation of the dorsal $agalnucleus from the

$agal nucleus, parasympathetic efferent fibers tra$el in

the $agus ner$e to the bronchi.


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The Treatment >ink

The link between rhinosinusitis and asthma ,

suggesting that when one condition is

effecti$ely treated, the other may impro$e

as well.

!dministering the intranasal corticosteroid

beclomethasone dipropionate to patients

with allergic rhinitis and asthma significantly

decreased bronchial hyperreacti$ity and

impro$ed asthma symptoms leading to

conclude that ignoring inflammation in

the upper airway is likely to lead to

suboptimal results in asthma treatment


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! reduction in nitric oxide, which is a potent

modulator of bronchial tone, may precipitate acute

bronchial hyperresponsi$eness .

#?R has a role in inducing the nasal mucosal

edema and inflammation that cause obstruction of the

sinus ostia, which in turn stimulates the autonomic

ner$ous system. The amount of pharyngeal reflux of

gastric acid is greater in patients with chronic sinusitisthat does not respond to initial antireflux therapy.

ther associated processes


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iagnosis

3istory.

/ymptoms.

/igns.

)n$estigations.Referral.


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%lan @ ray paranasal sinuses


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!sthma diminishes when coexistentrhinosinusitis is maximally treated by

medical or surgical inter$ention.

7edical treatment include.antihistamines ,topical intranasal

corticosteroids , decongestants,

sinopulmonary la$age and broad-

spectrum antibiotic therapy 0when

indicated1.The role of medication in treatment isto reduce chronic inflammation

associated with asthma and coexisting

noseA paranasal sinus disease.

Treatment strategies


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!ntihistamines effecti$ely block 38receptors

and function as anti-inflammatory agents.

econgestants can significantly affect ostial

blockage .

Topical intranasal corticosteroids has a

profound effect on reducing tissue edema and

inflammation in the sinuses.

!ntibiotic should be used only ifthere is

infection.

7edical Treatment


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2unctional endoscopic sinus surgery

02?//)

2?// on 8:B rhinosinusitis Casthmatic

patients monitored for an a$erage of

=.Byears after 2?// was performed.

!bout 9DE of patients impro$ed

asthma symptoms.

'enefit was demonstrated by

F>ess fre&uent use of a beta-agonistinhaler in BDE of patients.F 2ewer need of oral corticosteroid to

control acute asthma exacerbations

in ==E of patients.


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>ow >e$el >aser Therapy of /inusitis


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2uture of allergy treatment!nti )g?

@olair 0omaliumab12inally appro$ed by the 2!for adults and teens with moderate-to-se$ere

allergic asthma, itGs a new kind of allergy drug.


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%romising agents for steroid reduction in

persons with allergic asthma.

7ay protect against acute allergen-inducedexacerbation.

4ot antigen specific.

@olair 0omaliumab1


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7ay ha$e uses in other allergic diseases.

4ot e$ery case of asthma is triggered by anallergic reaction.. ?xercise, cold outdoor

temperatures and other factors may be the

seminal e$ent in susceptible indi$iduals. *hile

those cases, too, are characteried by

inflammation and narrowing of the airways.

Tanox is de$eloping a similar drug, known as

T4@-9D8.

@olair 0omaliumab1


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5onsiderable clinical and research e$idence

substantiates the interrelationship between

rhinosinusitis and asthma.

ptimal treatment of asthma depends on

aggressi$e management of associated

rhinosinusitis.

Rhinosinusitis is best managed by the use of

antihistamines, intranasal corticosteroids,

decongestants, sinus la$age to maintain ade&uate

mucociliary clearance

!ntibiotics should be used only if needed.

!nti )g? is a promising treatment for allergic

diseases.

5onclusions


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#i$en by inection once or twice a

month, it lets many patients cut

back on other asthma drugs.

! genetically engineeredantibody0!nti )g?1 that blocks the

cascade of e$ents in the body that

triggers allergic asthma .

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Lectures-PPS-Sinusitis.pps