Pediatric Rhinosinusitis and Comorbid Asthma

Pediatric rhinosinusitis is characterized by the inflammation of the nose and the paranasal sinuses accompanied by at least two symptoms such as nasal obstruction, nasal congestion, or nasal discharge. Facial pain, facial pressure, and cough can accompany these symptoms. Presence of comorbidities like adenoid hypertrophy, allergic rhinitis, gastroesophageal reflux, and asthma may cause negative clinical consequences and week disease control in patients who have CRS. The probability of detecting CRS is higher in severe asthma patients. CRS and asthma are both characterized by eosinophilic inflammation. Eosinophilic inflammation is more severe in patients with CRS and comorbid asthma. According to nasal endoscopic and CT findings, the two major phenotypes of CRS are as follows: CRS with nasal polyposis (CRSwNP) and CRSsine nasal polyposis. Even though less prevalent, CRSwNP is more frequent in patients with asthma which share the same T helper 2 immune response. Early detection of upper airway pathologies is crucial, especially in patients who have severe asthma. For this reason, nasal endoscopy and imaging are recommended in these patients. In patients with asthma, rhinosinusitis treatment improves asthma symptoms, respiratory function, and airway hyperreactivity. In addition, recovery in asthma symptoms quality-of-life scores was observed after endoscopic sinus surgery in patients with CRS resistant to medical treatment and comorbid asthma. High index of suspicion and early attention and treatment of both CRS and asthma are required for successful clinical management of CRS and asthma.