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A chest physician's guide to mechanisms of sinonasal disease
  1. V Hox1,2,
  2. T Maes3,
  3. W Huvenne4,
  4. C Van Drunen5,
  5. J A Vanoirbeek6,
  6. G Joos3,
  7. C Bachert4,
  8. W Fokkens5,
  9. J L Ceuppens2,
  10. B Nemery6,
  11. P W Hellings1,2
  1. 1Clinical Division of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
  2. 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
  3. 3Laboratory for Translational Research in Obstructive Pulmonary Diseases, Department of Respiratory Medicine, Ghent University Hospital, Belgium
  4. 4Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Belgium
  5. 5Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
  6. 6Research Unit of Lung Toxicology, Department of Public Health, K U Leuven, Leuven, Belgium
  1. Correspondence to Dr Valerie Hox, Clinical Division of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; valeriehox{at}


The upper and lower airways are closely linked from an anatomical, histological and immunological point of view, with inflammation in one part of the airways influencing the other part. Despite the concept of global airway disease, the upper airways tend to be overlooked by respiratory physicians. We provide a clinical overview of the most important and recent insights in rhinitis and rhinosinusitis in relation to lower airway disease. We focus on the various exogenous and endogenous factors that play a role in the development and aggravation of chronic upper airway inflammation. In addition to the classical inhaled allergens or microorganisms with well-defined pathophysiological mechanisms in upper airway disease, environmental substances such as cigarette smoke, diesel exhaust particles and occupational agents affecting lower airway homeostasis have recently gained attention in upper airway research. We are only at the beginning of understanding the complex interplay between exogenous and endogenous factors like genetic, immunological and hormonal influences on chronic upper airway inflammation. From a clinical perspective, the involvement of upper and lower airway disease in one patient can only be fully appreciated by doctors capable of understanding the interplay between upper and lower airway inflammation.

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