Asthma Complexities (cont.)

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The allergic rhinitis-asthma connection

There is a clear association between allergic rhinitis (hay fever) and asthma. The question of which comes first -- the allergic rhinitis or the asthma -- is not easily answered. Many patients recall developing their asthma and nasal symptoms at or about the same time. Others developed their asthma either before or after the onset of their allergic rhinitis. We now know that almost all patients with allergic asthma also have allergic rhinitis. Additionally, roughly one-third of people with allergic rhinitis will develop asthma. Patients with both conditions can expect to suffer more severe asthmatic attacks and require stronger medications to treat their asthma. Patients with allergic rhinitis should be vigilant about reporting any persistent coughing or wheezing to their doctors. The presence of asthma can easily be determined with pulmonary function tests.

The following are possible reasons why allergic rhinitis and asthma are related:

  • The nasal and bronchial membranes are made up of almost the same type of tissue.
  • The nerves of the upper airway (nasal cavity) and the lower airway (bronchial tubes) are connected. Both the upper and lower airways are exposed to the same external environment during breathing. When allergens reach the nasal cavity, there is stimulation of nerve endings in the nasal cavity. This stimulation causes reflex neural signals to be sent to the tissues of both the nasal cavity and the lower airways. In the nasal cavity, these signals cause accumulation of fluid and the formation of mucus, while in the bronchial tubes they cause bronchial constriction and possibly acute asthma. This is sometimes referred to as the naso-bronchial reflex.
  • Nasal congestion causes mouth breathing. During mouth breathing, air bypasses the nose. It is not filtered for allergens and irritating particles, and it is not warmed or humidified. This non-conditioned air is more likely to cause bronchial hyperreactivity and produce asthma symptoms.
  • Mucus from the nasal cavity may drip from the back of the nose into the bronchial tubes, especially during sleep. This dripping mucus increases bronchial inflammation and causes episodes of asthma at night.
Medically Reviewed by a Doctor on 1/24/2014

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