Chronic sinusitis

Sinuses are air-filled hollow cavities present in the face; they produce mucus that drains through the nose to help clean the air you breathe. Chronic sinusitis is described as inflammation of the nasal cavities for more than 12 weeks. This leads to a stuffy nose, hence, breathing becomes difficult.¹ 

What causes sinusitis?

There can be multiple factors contributing to sinusitis:²

• Bacterial infections 
• Vital infections 
• Fungal infections 
• parasitic infections 
• Allergens 
• Haemophilus influenzae 
• Vaccinations are not up to date
• Asthma 
• Nasal polyps 

Symptoms of sinusitis 

Common symptoms of sinusitis includes:²

• Runny nose 
• Post-nasal drips 
• Fullness around the eyes
• Headache 
• Dizziness 
• Pressure around the face 

What is wheezing?

Heezing is defined as a whistling sound that occurs during breathing because of narrowing of the bronchial airways.³

What causes wheezing?

Narrowing of the bronchi and bronchioles leads to decreased velocity of air, and fluttering of the narrowed airways produces a whistle sound. The usual causes of wheezing include:³

• Anaphylaxis ( hypersensitive allergic reaction ) 
• Allergy 
• Pneumonia 
• Chronic obstructive pulmonary disease ( COPD)
• Pleural effusion 

Typically, wheezing is associated with asthma. However, it can also be associated with chronic sinusitis. In this article, we will discuss the relationship and correlation between wheezing and sinusitis. 

Is chronic sinusitis related to pneumonia?

Chronic sinusitis has shown a correlation with lower respiratory tract infection. A meta-analysis on sinusitis associated with ventilator use proposes the result that around 41% of patients with sinusitis secondary to ICU admission develop lower respiratory tract infections, including pneumonia that presents with wheezing. Furthermore, the study showed that the same pathogen was identified in the lungs that was found inside the nasal cavity. Hence, upper airway infections, including sinusitis and lower airway infections like pneumonia, are correlated as both upper and lower airways are considered as a single unit.⁴

The connection between chronic sinusitis and wheezing 

Chronic sinusitis has a strong correlation with wheezing and often go hand-in-hand. 

Inflammatory pathways

Understanding the phenomenon of single airway units is crucial to understanding the correlation between sinusitis and wheezing. Upper and lower airways work as a single unit, meaning they share the same pathophysiology. This means that a nasal allergen can cause inflammation of the lower airways and vice versa. This phenomenon is termed a “united airway hypothesis”.³

Post-nasal drips 

Nasal dribbling can be extremely irritating to the trachea (windpipe). This causes accumulation of the mucus within the trachea, and the mucus can clog the windpipe and cause blockage of the airways, which may exacerbate wheezing.

Allergic rhinitis and asthma 

According to studies, the probability of having allergic rhinitis and asthma increases with age and people having allergic rhinitis were found to have 75% chance of having asthma. Hence, these two conditions are closely interrelated.⁵

Medical management

How to treat sinusitis 

Non-pharmacological management 

• Hydration with rest is the first step to treat sinusitis 
• Steam inhalation also helps to clear out the mucus that is trapped inside the sinuses.
• Avoid smoking as it triggers an allergic reaction
• Nasal irrigation with salt water

Pharmacological management

• Steroid nasal spray 
• Anti allergic 
• Analgesics, including Paracetamol and NSAIDS 

How to treat wheezing?

There are certain methods to treat wheezing, some of which include 

• Reducing allergens and triggers

By reducing the triggers, the risk of asthma progression and wheezing significantly decreases. An allergen can be any substance that triggers an allergic reaction in the body to produce certain inflammatory markers that can lead to reduced air entry into the lungs, thereby obstructing breathing. This leads to wheezing.

• Avoidance of active and passive smoking

Smoking leads to the production of inflammatory markers and mucus. As discussed earlier, this leads to asthma by decreasing the air entry into the lungs.

• Use of a short-acting beta agonist 

Short-acting beta agonists like albuterol are bronchodilators that are helpful in dilating the bronchioles quickly and effectively. These drugs act on the beta receptors and activate them, leading to dilation of the bronchioles.

• Use of long-acting bronchodilators

For more chronic asthma and wheezing, long-acting beta 2 agonists such as salmeterol are used as their effect of bronchodilation lasts longer.^3,6

Combined approaches 

Behavioural and lifestyle interventions

A patient with both chronic sinusitis and asthma: How combined treatments improved outcomes.

When discussing the treatment options one has for conditions like asthma and chronic sinusitis, it is better to opt for a combined approach as it is most effective. 

The treatment goal is to improve the ventilation of the lungs and prevent obstruction by dilating the bronchioles. This includes starting the patient on bronchodilators, steroid inhalers, steam inhalation, and anti-inflammatory drugs, 

Summary

To conclude, the relationship between chronic sinusitis and asthma-related wheezing is codependent, and both have similar treatment modulators. This means that the management of one will have a significant effect on the other.

If sinusitis is left untreated can progress to the lower airway, causing worsening symptoms of wheezing, shortness of breath, cough and may potentially lead to pneumonia.

Currently, researchers have been going on to understand the relationship along with different management strategies to prevent and treat upper and lower respiratory infections simultaneously to prevent bad outcomes and worsening of the disease.

Implications for patient care

In order to effectively treat these conditions, it is imperative that different subspecialties, including infectious diseases specialists, pulmonologists and general physicians, join hands and provide a holistic patient care and treatment plan for short-term as well as long-term management of sinusitis and lower airway infections

Frequently asked questions 

Q: Is sinusitis the same as the common cold?

A: No, sinusitis is not the same as the common cold. It is a condition in which there is mucus deposition in the sinuses within the face. However, the common cold is usually caused by a virus and presents with flu-like symptoms.

Q: How do I know I have sinusitis?

A: Sinusitis presents with headache, facial pain and pressure-like symptoms.

Q: How do I know I have a common cold? 

A: Common cold presents with flu-like symptoms, for example, a runny nose, watery eyes, cough. Usually caused by a viral infection. 

Q: Are there natural remedies to treat sinusitis? 

A: Natural remedies to treat sinusitis include steam inhalation and drinking warm fluids.

Q: How can I prevent sinusitis?

Ans: You can wear masks to prevent dust and other allergens from getting into your system.

Q: What is a wheeze?

A: A wheeze is a whistle-like sound that is produced from the airways when we breathe in or out. It is produced because of the narrowing of the airways.

Q: Is sinusitis contagious? 

Ans: No, sinusitis in itself is not contagious, but it can be caused by various bacteria or viruses which may affect many people in the same space.

Q: Is sinusitis related to asthma? 

A:  People who have sinusitis can develop symptoms of asthma, along with wheezing. This is usually triggered because of post-nasal drip.

Q. Is childhood asthma related to sinusitis?

A: Asthma in general correlates with sinusitis; hence, children with asthma have greater chances of developing sinusitis in adulthood. 

Q: What is the treatment that works best for sinusitis and asthma? 

A: Treatment modalities often include both pharmacological and non-pharmacological options. This includes steroid inhalers, anti-allergic medications, short-acting beta agonists – drugs that dilate the lung bronchioles and anti-inflammatory medications.