Pathogenic Factors and Therapeutic Options

Thomas B. Casale, M.D. ( Nebraska Medical Research Institute, Papillion, NE ): Asthma and rhinitis are two respiratory diseases commonly investigated, researched, and treated by American Thoracic Society members. These diseases are linked pathogenically, epidemiologically, and therapeutically. For example, a majority of patients with asthma have been reported to have nasal symptoms versus only a minority of the general population. The prevalence of asthma in patients with rhinitis is much higher than that reported in the general population. Pathophysiologic events critical to the development and clinical manifestations of these two diseases are similar. Indeed, many of the cells, mediators, cytokines, and neurotransmitters important in the biology of asthma and rhinitis are the same. Treatment of rhinitis has been shown to improve pulmonary function and decrease symptoms in patients with asthma. Furthermore, systemic therapies can treat both diseases concomitantly. At a workshop titled “Immunobiology of Asthma and Rhinitis: Pathogenic Factors and Therapeutic Options,” held in Montreal, Canada in June 1997, participants discussed commonalties and differences between asthma and rhinitis with regard to ( 1 ) pathogenesis (in the context of the structure and function of the upper and lower airways), including immune effector cells, mediators, neurogenic pathways, and immunobiology; ( 2 ) incidence, prevalence, and comorbidity of asthma and allergic rhinitis, examining each from the perspective of whether they are distinct entities, coincidental diseases, or interrelated conditions; and ( 3 ) treatment, with a focus on distinct therapies as well as current and future concomitant therapies. Specific sessions focused on four themes: ( 1 ) Immune Effector Cells and Mediators in the Pathogenesis of Asthma and Rhinitis; ( 2 ) Relationship between Neurogenic Pathways and Immunobiology of Asthma and Rhinitis; ( 3 ) Incidence, Prevalence, and Comorbidity of Asthma and Rhinitis; and ( 4 ) Current Therapies and Future Prospects for the Concomitant Treatment of Asthma and Rhinitis. What follows is an Executive Summary of the Workshop Proceedings, which focuses on the four themes and concluding commentaries. The full text of the proceedings is available in print and on the World Wide Web through the American Thoracic Society at www.thoracic.org/statements/rhinitis/rhinitis.html.

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