2016 Section 5 Green Book

Comorbidities of asthma and the unified airway

Conclusion It is essential that otolaryngologists, head and neck sur- geons, and allergists become familiar with the unified airway concept when managing our patients with AR. Asthma and AR are closely related epidemiologically and biologically. 1–12 Early and aggressive therapy to treat AR may prevent the progression of the disease to asthma. Healthcare providers who are aware of the close relation- ship of AR to asthma may be able to identify the early signs of asthma, enabling prompt treatment and preventing dis- ease progression. Furthermore, appropriate management of AR has been shown to improve asthma control.

remodeling. Remodeling involves tissue injury and subse- quent repair. The pathophysiologic events included in this phenomenon are mucosa edema, vasodilation, cellular infil- tration, epithelial injury, smooth muscle and mucous gland hypertrophy, angiogenesis, collagen deposition, basement membrane thickening, and subepithelial fibrosis in the lam- ina reticularis 50,60–62 (Table 1). Similar findings are seen in chronic rhinosinusitis although the reticular basement membrane thickening is not as pronounced in the nasal epithelium as it is in the bronchial epithelium. It is important to note than even when symptoms appear to be under control, the inflammatory process in asthma can be ongoing and progressive. 72

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