Introduction

Asthma is a chronic respiratory condition that often starts in childhood, causing the airways to become inflamed, swollen and increasingly narrow. Ultimately, making it harder to breathe. Common symptoms of asthma in children include wheezing, shortness of breath, and coughing. The prevalence of asthma increases with age, with 5.8% more children affected by adolescent years than at ages 0 to 4. Before age 20, males have a higher prevalence of asthma than females.¹

Sinusitis is where the sinuses, air-filled spaces situated in the skull above the nasal cavity, become swollen. This is usually caused by an infection and typically resolves on its own. Symptoms of sinusitis include pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked nose, limited smell, mucus from your nose, and an elevated temperature.²

This article aims to explore how sinusitis affects children with asthma, how to manage and treat sinusitis in these patients, and any complications which may occur.

How Sinusitis Can Trigger or Worsen Asthma

Inflammation in the Airways

Sinusitis causes the upper airways to become inflamed, resulting in swelling and congestion in the nasal passages. In children with asthma, this inflammation can spread into the lower airways, where asthma symptoms occur. When the upper and lower airways are inflamed simultaneously, the child will experience increased difficulty breathing and exacerbated asthma symptoms. Uncontrolled sinusitis can therefore intensify asthma by increasing overall airway inflammation, making asthma harder to manage.

Increased Mucus Production

Sinusitis results in excessive mucus production in the sinuses as the body tries to combat infection or allergens, expelling dead cells and pathogens. This excess mucus can lead to postnasal drip, where the mucus drains down the back of the throat. In children with asthma, postnasal drip can irritate the airways, causing them to narrow further. The irritation can trigger asthma symptoms, making it harder for children to breathe effectively. 

Breathing Difficulties

The sinus becomes congested from inflammation or mucus buildup which obstructs normal airflow and increases breathing difficulty. This congestion places additional strain on an asthmatic child’s respiratory system, which can worsen asthma symptoms and lead to increased effort needed to complete a breath (respiratory effort). Over time, sinusitis-related congestion and the added stress on breathing can make asthma more severe and challenging to control.³

Common Symptoms When Sinusitis and Asthma Co-Occur

When a child with asthma develops sinusitis, the following symptoms occur:⁴

• Coughing: Sinusitis contributes to coughing through the postnasal drip, while mucus buildup characteristic of asthma can also cause coughing
• Nasal congestion: Caused by both asthma and sinusitis
• Wheezing: Caused by asthma, worsened by sinusitis
• Shortness of breath: Caused by asthma, worsened by sinusitis
• Chest tightness: Caused by asthma, worsened by sinusitis
• Headaches and pressure in the face: Caused by sinusitis

Complications and Risks

Sinus inflammation seen in sinusitis can spread to the lower airways, causing the lower airways to become more sensitive to asthma triggers. As a result, children with asthma will suffer more frequent flare-ups and increased susceptibility to asthma attacks. In more severe cases, sinusitis can provoke intense asthma exacerbations, requiring medical interventions such as emergency inhaler use, steroids, or even hospitalisation. 

Additionally, inflammation in both the sinuses and the lower respiratory tract reduces the effectiveness of asthma treatments, such as corticosteroids and bronchodilators, leading to limited resolution of symptoms. These conditions also prolong the recovery of the other and often exacerbate each other’s symptoms. 

If sinusitis is left untreated or poorly managed, it may develop into chronic sinusitis, where the inflammation lasts for months. Chronic sinusitis can contribute to persistent asthma symptoms, as the constant inflammation keeps the airways inflamed and reactive. This ongoing cycle can lead to long-term respiratory issues, where asthma symptoms like coughing, wheezing, and shortness of breath become a daily occurrence. Managing both conditions effectively is critical to preventing chronic complications and improving quality of life.³

Diagnosis and Management

Diagnosing Sinusitis in Children with Asthma

Diagnosing sinusitis in children with asthma involves a thorough clinical evaluation of symptoms such as nasal congestion, facial pain, and a prolonged cough lasting more than 10 days. These symptoms often overlap with asthma, making it essential to distinguish between the two conditions. For chronic or severe sinusitis, imaging studies like X-rays or CT scans may be required to get a clearer picture of sinus inflammation or blockage. These scans can help identify long-term issues, such as chronic sinusitis, which may be contributing to ongoing asthma symptoms.

Medical Management

Nasal corticosteroids are commonly prescribed to reduce sinus inflammation and swelling, improving airflow and minimising mucus buildup. In cases of bacterial sinusitis, antibiotics may be necessary to clear the infection. Asthma management remains crucial during sinusitis flare-ups, with inhaled corticosteroids, bronchodilators, and rescue inhalers used to control asthma symptoms. Close coordination between treating sinusitis and maintaining proper asthma care helps to reduce the risk of exacerbations.

Preventive Measures

Managing allergens and triggers, such as dust, pollen, and smoke, can prevent sinusitis and asthma from flaring up. Encouraging hydration and using nasal irrigation can help keep the sinuses clear of excess mucus, reducing the likelihood of congestion and subsequent asthma symptoms. Regular asthma check-ups are also important to monitor lung function and ensure that the child’s asthma action plan is up to date, allowing for better control of both conditions in the long term.⁵

Summary

• Sinusitis can trigger and worsen asthma in children through inflammation in the respiratory tract, increased mucus production, and breathing difficulties
• Symptoms of asthma are exacerbated by sinusitis, making both conditions more difficult to manage and treat
• Sinusitis often leads to more frequent asthma flare-ups and can cause severe exacerbations that may require medical intervention
• Treatment includes nasal corticosteroids to reduce sinus inflammation, antibiotics for bacterial sinusitis, and asthma medications like inhalers and bronchodilators
• Consistent asthma check-ups and maintaining an updated asthma action plan are essential for controlling asthma and sinusitis effectively