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Medical Author:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Unusual symptoms of asthma
• Can a cough without wheezing be due to asthma?
• Nocturnal asthma
• Masqueraders of asthma
• Cardiac asthma
• Other bronchial conditions
• Vocal cord dysfunction (VCD)
• Other hypersensitivity reactions
• Exercise and sports
• Exercise induced asthma (EIA)
• What causes exercise induced asthma?
• What sports are best suited for exercise induced asthma? What sports are not?
• Ways to prevent and treat exercise induced asthma
• Conditions that may worsen asthma
• Gastroesophageal reflex disease
• The allergic rhinitis-asthma connection
• Sinusitis and asthma
• Air pollution
• Food allergy
• Asthma Complexities At A Glance
• Find a local Asthma & Allergy Specialist in your town
• Asthma Complexities Index

Over the years, physicians have noted an association between asthma and sinusitis. In fact, 15% of patients with sinusitis also have asthma (as opposed to 5% of the normal population). An astounding 75% of severely asthmatic patients also have sinusitis. Additionally, asthmatic patients often report that their symptoms worsen when they develop sinusitis. Conversely, when the sinusitis is treated, the asthma improves.

The reasons behind the association of asthma and sinusitis are similar to those suggested for the association between asthma and allergic rhinitis.

• The infected mucus from the sinuses may drain into the bronchial tubes, thereby causing bronchitis (sinobronchitis). The inflammation caused by the mucus may worsen asthma.



• The best evidence to date seems to support the idea of neural reflexes in the linings of the nose, sinuses, and airways. Sinusitis may activate a "sinobronchial reflex" and worsen asthma.

Greater insight into how these two conditions are related may allow better control or even cure of these common conditions.

Poor air quality is known to worsen asthma symptoms and increase exacerbations. Diesel emissions are associated with asthma and increased symptoms. Living closer to freeways may result in more frequent exacerbations. Patients with asthma are at increased risk for symptoms when smog, soot, or ozone levels are significantly elevated. Children with smaller body size and developing lungs are at increased risk for breathing problems. Indoor air pollution may also be a contributing factor. In the third world, indoor fires used for cooking are often associated with respiratory illness. In the industrialized world, formaldehyde, tobacco smoke, dust mites, and other particles can worsen asthma.

Air filters are suggested by some to help minimize their effects on asthmatic patients. Research studies would suggest that maintaining adequate ventilation and modifying the household (removing carpets and drapes, using hypoallergenic mattress covers) may be enough. Some air-filtration systems may reduce some secondhand tobacco smoke, but no system can remove all the harmful components from this smoke. There are no standards for air filtration approved by the Food and Drug Administration (FDA). It does rate some portable air-filtration systems as Class II medical devices, indicating safety and medical benefit. If one of the devices is being considered for personal use, it is important to check that the device has this Class II approval. There are several different types of air filters. Mechanical filters force air through a mesh trapping particles. HEPA (high efficiency particulate air) are mechanical filters that capture at least 99.97% of all particles 0.3 microns or larger. Electronic filters use electrical charges to attract and deposit allergens and irritants on collecting plates. There are also hybrid systems that contain both mechanical and electronic filters. All of these can produce some ozone but usually at acceptable levels. Gas phase filters can remove odors and gasses such as cooking gas, fumes from paints and building materials, and perfume. They do not remove any allergenic particles. Ozone generators are ozone producers. This gives the "smell of clean air." Unfortunately, the ozone levels produced are often higher than acceptable levels. These devices are not recommended.