Nasal and sinus involvement in chronic obstructive pulmonary disease

Abstract

In patients with chronic obstructive pulmonary disease, nasal inflammation often coexists with lower respiratory disease. We review the current understanding of the relationship between upper and lower airway disease, particularly in chronic obstructive pulmonary disease, including therapeutic implications. There is growing evidence of pan-airway involvement in chronic obstructive pulmonary disease. Recent studies suggest that the degree of nasal airway obstruction reflects the severity of pulmonary airflow limitation and the degree of upper airway and systemic inflammation correlates with that of lower airway inflammation. There are also data which show that treating nasal and sinus disease can improve the global quality of life and decrease lower airway symptoms in patients with chronic obstructive pulmonary disease. Patients with chronic obstructive pulmonary disease should be assessed for coexistent rhinosinusitis. Therapy directed toward treating the upper airway is likely to improve the global health status of these patients. Since tobacco smoke can exacerbate upper airway symptoms, it is important to evaluate patients with rhinosinusitis for concomitant lower airway disease.