One Airway Disease - Chronic Rhinosinusitus and Asthma

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nasal and paranasal sinus mucosa. At least 50% of patients with CRS are reported to have asthma. Eosinophilic inflammation is the major histologic hallmark of both diseases. The cytokine patterns found in CRS sinus tissue are similar to those of asthma lung tissue. Asthma is characterized by airway remodeling, but similar remodeling has not been described in CRS. In this issue of the Journal, Ponikau and coworkers report on the histologic findings from 22 patients with refractory CRS who underwent endoscopic sinus surgery. The investigators report that specimens from all 22 patients revealed epithelial shedding and basement membrane thickening. Strikingly heterogeneous eosinophilic inflammation was present in all CRS patients, and allergic and nonallergic patients did not differ with respect to this inflammation. these findings in the sinus mucosa are simular to findings in the lower airways in patients with asthma. The presence of common histopathologic findings, coupled with the common clinical coexistence of both diseases, suggested to the authors that a single pathologic disease process is manifest as CRS in the sinonasal tissue and as asthma in the lower airway.