Indian J Allergy Asthma Immunol 2002; 16(1) : 23-26

A Study on Significance of Association of Chronic Sinusitis with

Bronchial Asthma
S.H. Talib, Shailaja Rao, D.S. Kulkarni$, Jeet Singh
Department of Medicine, $ Department of Radiology, Government of Medical College, Aurangabad
Abstract
Rhinosinusitis and asthma represents the most important link of one disease in different organs. The
involvement of maxillary, anterior ethmoidal and frontal sinuses draining via the ostiomeatal complex
may result in chronicity and severity of bronchial asthma. Subjects treated with antihistaminics in
addition to antibiotics and steroids have shown significant and faster relief of asthma symptoms. Present
study undertaken to know predisposition of sinus involvement in 50 asthmatic patients.
Key words: Sinusitis, Asthma

MATERIAL AND METHODS

INTRODUCTION

Literature is now abundant on information on the

relationship between sinusitis and asthma. The
studies have confirmed that the disease sinusitis and
asthma occur as comorbidities in same individual
wherein former is known to influence the bronchial
asthma in its severity and chronicity. Hypotheses are
forwarded that upper and lower airways need to be
considered as different stages of unique entity
influenced by common mechanisms in the
inflammatory process. Sinusitis and asthma therefore,
are considered as manifestations of one disease
process.
Present study is designed to know the incidence of
sinusitis in asthmatic population. Clinical and
roentgenological studies were undertaken. The study
was extended to record and compare the relevant
findings pertaining to sinus involvement obtained by
clinical and roentgenological studies.
IJA A I. 2 0 0 2 , XVI ( l ) p 23-26

23

Study was carried out at the Department of

Medicine, Government Medical College Aurangabad.
50 cases of bronchial asthma were studied. Asthmatic
patients were selected as per the guidelines advocated
by ATS in 1995.1 All these asthmatics were screened
for clinical and roentgenological evidence of sinusitis.
The clinical criteria for diagnosing sinusitis was
the presence of2
(1) Nasal congestion/stuffiness, (2) Nasal
discharge, (3) History suggestive of post-nasal
dripping, (4) Local pain and tenderness over the sinus,
(5) Night cough, (6) Unpleasant smell or taste (Fetor
oris).
The roentgenological criteria for diagnosing
sinusitis was adopted as described by Dolan (1989).3
i.e. the presence of
(1) Mucosal thickening, (2) Opacity of sinuses,
(3) Airfluid levels.

INDIAN J ALLERGY ASTHMA IMMUNOL 2002; 16(1)

24

The CT criteria for the diagnosis of sinusitis was

the presence of3
(1)

Mucosal thickening > 6 mm in children and

> 8 mm in adults,

(2) Indistinct bony margins,

(3) Erosion of mucoperiosteum,
(4) Obstruction of ostiomeatal complex.
Other associated anatomical abnormalities
responsible for chronic inflammation and recurrent
chronic sinusitis, were also recorded.
Roentgenogram of paranasal sinus (Waters view)
and CT scan of paranasal sinus (without contrast)
was performed in all 50 patients of bronchial asthma.
RESULTS

Fifty patients (26 male and 24 female, M:F 1.08:1)

comprised the study group. Age of patients ranged
from 16-58 years with mean age of 32.78 years. As
per history and clinical examination 29 (58%) patients
had symptoms and signs suggestive sinusitis. The
most common symptom was nasal congestion found in
26 (52%) patients (Table-1). On sinus
Table 1. Various symptoms and signs of sinusitis in 50 patietns of
bronchial asthma

roentgenogram (Waters view), 33 (66%) patients

had evidence of sinusitis. Maxillary sinusitis was
found in all these 33 (66%) patients. Frontal sinusitis
was seen in 18 (36%) patients, DNS in 11 (22%)
patients and maxillary polyp in 4 (8%) patients. 17
(34%) patients had normal sinus roentgenograms
(Table 2).
CT scan PNS showed evidence of sinusitis in 39
(78%) patients whereas 11 (22%) patients had no
evidence of sinusitis. Maxillary sinusitis was found
in 39 (78%) patient, and 26 (52%) patients had frontal
sinusitis. Ethmoid sinusitis was seen in 11 (22%)
patients and 4 (8%) patients had sphenoid sinusitis.
Maxillary polyp was found in 11 (22%) patients and
ostiomeatal complex block in 27 (54%) patients
(Table-3).
The findings of sinusitis obtained on roentgnogram
of PNS and CT PNS when compared, revealed that
maxillary sinusitis found in 33 (66%) patients on
roentgenogram and in 39 (78%) patients on CT scan.
Frontal sinusitis was seen in 18 (36%) patients on
roentgenogram and 26 (52%) patients on CT scan.
The presence of ostiomeatal complex block and
anatomical abnormalities were exclusively detected
by CT scan (Table-4). Among 50 patients of bronchial
asthma, clinically 29 (58%) patients had evidence of
sinusitis 33 (66%) patients showed roentgenological
evidence of sinusitis whereas CT scan detected
sinusitis in 39 (78) patients (Table-5).

Table 2. Findings of Roentgenogram of Paranasal Sinus (Waters

View) in 50 Patients of Bronchial Asthma

CHRONIC SINUSITIS ASSICIATED WITH BRONCHIAL ASTHMA

Table 3. Findings of CT Scan Paranasal Sinus in 50 Patients of
Bronchial Asthma

25

Table 5. Comparison of cases of chronic sinusitis detected by

various parameters in 50 patients of bronchial asthma

DISCUSSION

In the present study, clinically 29 (58%) patients

out of 50 patients of bronchial asthma had signs and
symptoms of sinusitis whereas 21 (42%) patients
were asymptomatic for sinusitis (Table-1). On
roentgenogram PNS (Waters view) 33 (66%) out of
50 patients showed evidence of sinusitis (Table 2).
Patients who were clinically symptomatic (29
patients, 58%) for sinusitis also had roentgenological
evidence of sinusitis. In addition sinusitis was
detected in 4 (19%) patients out of 21 clinically
asymptomatic patients.

Table 4. Comparison of the findings of roentgenogram paranasal

sinus (Waters view) and CT scan paranasal sinuses in 50 patients
of bronchial asthma

On CT scan of paranasal sinus, 39 (78%) patients

of bronchial asthma showed evidence of sinusitis
(Table-3). All 29 patients who were clinically
symptomatic for sinusitis, had evidence of chronic
sinusitis on CT scan PNS. In addition, on CT scan
PNS 10 (47%) more patients were detected to have
sinusitis out of 21 clinically asymptomatic patients.
27 (54%) patients showed evidence of ostiomeatal
complex block (Table-3). The ostiomeatal complex is
the common drainage pathway for maxillary,
frontal and anterior ethmoid sinuses. CT scan has
given newer understanding of how the patient is
affected with sinusitis.
The anatomical abnormalities affecting the nose
and paranasal sinuses were specifically looked for, as
these predisposed to chronic and recurrent sinusitis.
Two anatomical abnormalities were found including
concha bullosa in 16 (32%) patients and deviation of
nasal septum (DNS) in (66%) patients (Table-3), both
these findings are found more frequently in our
studied asthmatic group. In general population, the
incidence of concha bullosa and DNS as reported in
literature is 25% and 27% respectively.4

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INDIAN J ALLERGY ASTHMA IMMUNOL 2002; 16(1)

The possible mechanisms explaining the

relationship of sinusitis and asthma include the
sinonasal bronchial reflex, the eosinophils and the
inflammatory mediators including leukotrienes,
prostaglandin D2 and histamine. Out of these three
postulates, sinonasal bronchial reflex seems to be of
much importance.
The sinonasal bronchial reflex theory asserts that
stimulation of neural receptors in the nose and sinuses
activates trigeminal afferent pathways and produces
broncho constriction through a vagal efferent.5
Though for some unknown reasons, this sinonasal
bronchial reflex does not seem to operate in some
individuals. It may be possible that some critical
threshold of nasal disease is required for the lower
airway to respond.5
Evidences suggest that the eosinophils play an
important role in mediating injury to bronchial
epithelium in chronic asthma. The eosinophil also act
as an effective cell in chronic inflammatory disease
in paranasal respiratory epithelium. It may be possible
that the sinus disease in patients with asthma may have
the same mechanism6.
Another proposed mechanism for sinusitis as an
precipitator of asthma is production of inflammatory
mediators that could either be aspirated into the lower
airways or locally stimulate the irritant receptors in
the sinuses with resultant reflex bronchospasm.7
In the present study out of 50 asthmatics evidence
for sinusitis was found clinically in 58% cases while
roentgenogram PNS and CT scan PNS detected
sinusitis in 66% and 78% cases respectively. This
observation assumes significant clinical importance
that all asthmatics need to be examined for evidence
of sinusitis preferably by CT scan. The scan is also

beneficial in detecting all the obscured anatomical

abnormalities with high accuracy.
The epidemiological studies have shown that 2550% of patients with allergic rhinosinusitis have
asthma and 70% of asthmatics suffer from rhinitis.8
The disease association with asthma as a comorbid
pathology has clearly defined the entity as one
airway and one disease. It is very pertinent to
mention that ENT specialist must look down into
chest for evidence of bronchospasm and chest
physicians should examine asthmatic patients for
evidence of rhinosinusitis.
REFERENCES
1.

American Thoracic Society. Standards for the diagnosis and

care of patients with chronic obstructive pulmonary disease &
asthma. Am J Respir Crit Care Med. 1995; 152 : S77-S120.

2.

Salvin RG. Sinusitis in adults and its relation to allergic rhinitis,

asthma and nasal polyps. J Allergy Clin Immunol. 1988; 82 :
950-56.

3.

Dolan K. Radiology of nasal cavity and paranasal sinuses. In :

Cummings C, Krouse CJ. Eds. Otolaryngology Head and Neck
Surgery, Chicago. Mosby Year Book Inc. 1989; 853-62.

4.

Havas TE, Bery JA, Gullane PJ. Prevalence of incidental

abnormalities on computerised tomographic scans of the
paranasal sinuses. Arch Otol Head Neck Surg. 1988; 114 :
856-59.

5.

MacFadden ER. Nasal sinus pulmonary reflexes and bronchial

asthma. J Allergy Clin Immunol. 1987; 78: 1-3.

6.

Harlen SL, Ansel DG, Lane SR. A clinical and pathologic

study of chronic sinusitis: The role of the eosinophil. J Allergy
Clin Immunol. 1988; 81 867-75.

7. Stone BD, Georgitis JW, Mathews B. Inflammatory mediators in

sinus lavage fluid. J Allergy Clin Immunol. 1990; 85 : 222.
8.

Bousquet J. Allergic rhinitis as a global health problem. ACI

International 2001; 13 : 137.