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RESEARCH PRODUCT

The relationship between asthma and allergic rhinitis: exploring the basis for a common pathophysiology

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Summary Most patients with asthma also have rhinitis, and the same inflammatory cells and mechanisms are present in bronchial and nasal mucosa, thus leading to the concept of ‘one airway, one disease’. This concept is further substantiated by evidence of nasal inflammation in asthma, and bronchial inflammation and hyperresponsiveness in rhinitis. Endobronchial allergen challenge induces nasal and bronchial symptoms as well as reductions in pulmonary function and nasal patency. Likewise, treating rhinitis can improve the symptoms of asthma. There are some notable pathophysiological differences between the nose and the bronchi, for example airway remodelling appears to be less extensive in the nasal mucosa than in the bronchial mucosa. But, in spite of this, it is widely recognized that interrelated mechanisms contribute across the asthma–rhinitis disease spectrum. Of particular note is that the same pro-inflammatory mediators (e.g. cysteinyl leukotrienes, cytokines, histamine) are involved in nasal and bronchial inflammation, in patients with rhinitis and asthma. It appears there are ‘bidirectional’ relationships between nasal and bronchial inflammation, and that biological events occurring in the nose or lung promote widespread responses, thus mimicking a systemic disease.