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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

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.