United Airway ConceptNose and lungs: one way, one disease

Ika Maya sandy and Dian Rosita Devy

United Airway Disease

• The term “united airway disease” is increasingly being used to describe the inflammation that occurs in both the upper and lower airways

1. Martin, Sharyn. United Airway Disease. Last update 11 Nov 2011 [http://www.asehaqld.org.au/index.php/allergy-information/aeroallergens-irritants-and-respiratory-conditions/126-united-airway-disease?format=pdf]

2. Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf

Issue

Asthma

76 % had rhinitis

24 % without rhinitis

It’s All Connected – “Comorbid”

Focuses on the role of Rhinitis as a risk factor for Asthma

Impact Economic

More medication

Longer duration of time

• Physical barrier• Heater • Humidifier

1. Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf

WHO

Nose

Anatomy Martin, Sharyn. United Airway Disease. Last update 11 Nov 2011 [http://www.asehaqld.org.au/index.php/allergy-information/aeroallergens-irritants-and-respiratory-conditions/126-united-airway-disease?format=pdf]

The nasal and bronchial mucosa present similarities

Bousquet and the ARIA Workshop Group. Allergic Rhinitis and Its Impact on Asthma. The Journal Of Allergy and Clinical Immunology, Volume 108 No. 5, November 2001 [http://www.progetto-aria.it/materiale/aria_jaci.pdf]

12

3

Upper and lower airways

Similarity1 Differences2,3

• Ciliated collumnar cell epithelian lining

• Mucinous glands• Vasculature• Innervation

• vascularity in the nose

• Characteristic brochial smooth muscle in the lung

1. Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf]

2. Meltzer EO, Szwarcberg J, Michael. Allergic Rhinitis, Asthma, and Rhinosinusitis: Disease of the Integrated Airway. JMPC

3. Bousquet and the ARIA Workshop Group. Allergic Rhinitis and Its Impact on Asthma. J Allergy Clin Immunol Nov 2001

THE NASO BRONCHIAL CROSS TALK

Respiratory Track Single morphologic entity

Inflamasi

Affects whole system

MALT*

* mucosal associated lymphoid tissue

Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf]

Nasal allergen

Nasobronchial reflex arc

Bronchial hyperresponsiveness

Trigeminal afferents Vagal efferents

Meltzer EO, Szwarcberg J, Michael. Allergic Rhinitis, Asthma, and Rhinosinusitis: Disease of the Integrated Airway. JMPC

Initiate systemic release of inflamation mediator

Braunstahl. Allergic Rhinitis and Asthma: The Link Further Unraveled. 2003 [http://www.medscape.com/viewarticle/446398_3]

Triger

Triger reflex airways reaction

Infection Cigarette smoke &

pollutantsAtmospheric

VirusBacteria

• Rhinitis• Rhinosinusitis• Brochiolitis • Pneumonia

Chronic inflammation

Caimmi et al. Nose and Lung: One Way, One Diesease. Italian Journal of Pediatrics 2012, 38:60 http://www.ijponline.net/content/38/1/60

Vasodilatation

Vascular permeability >>

Mucus production >>

1. Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf]

2. Meltzer EO, Szwarcberg J, Michael. Allergic Rhinitis, Asthma, and Rhinosinusitis: Disease of the Integrated Airway. JMPC

Similarities and differences between asthma and rhinitis.

Focus Therapy

Inflamation

Anti-Inflamatory therapy As a backbone

Nasal symptom <<

Madication in asthma <<

Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf]

References

1.Martin, Sharyn. United Airway Disease. Last update 11 Nov 2011 [http://www.asehaqld.org.au/index.php/allergy-information/aeroallergens-irritants-and-respiratory-conditions/126-united-airway-disease?format=pdf]

2.Thomas. One AirwAy, One DiseAse, One Drug. [http://www.apiindia.org/pdf/medicine_update_2012/pulmonology_03.pdf

3.Meltzer EO, Szwarcberg J, Michael. Allergic Rhinitis, Asthma, and Rhinosinusitis: Disease of the Integrated Airway. JMPC

4.Caimmi et al. Nose and Lung: One Way, One Diesease. Italian Journal of Pediatrics 2012, 38:60 http://www.ijponline.net/content/38/1/60

5.Braunstahl. Allergic Rhinitis and Asthma: The Link Further Unraveled. 2003 [http://www.medscape.com/viewarticle/446398_3]