Role of sinusitis in asthma.

Chronic sinusitis has been suggested to play a causal role in creating recalcitrant asthma. However, this hypothesis has never been confirmed in a blind placebo-controlled study. Several studies have documented an association between abnormal sinus X-rays and asthma in 30-70% of patients, depending on criteria chosen for evaluation of the radiologic changes. Asthma is associated with inflammation in the lower airways, and the same inflammation might involve the sinuses in a parallel fashion. It is now felt that early therapy of this inflammation can modify the course of asthma resulting in its amelioration. Conversely, delay in institution of this therapy might result in the inflammation entrenching airway reactivity. It must be clearly proven in a controlled fashion that antibiotic or other therapy of sinusitis will improve the course of asthma since such therapy could delay the aggressive management of inflammation.