One-Airway Concept – Therapeutic Implications

Koncept alergijskog sindroma jedinstvenih dišnih putova temelji se na čvrstoj epidemiološkoj povezanosti, sličnim genskim i okolišnim čimbenicima rizika te činjenici da je alergijski rinitis izravni čimbenik rizika od nastanka astme. Imunopatologija astme i rinitisa, glavnih sastavnica ovog sindroma, vrlo je slična, a postoje i brojni histopatološki dokazi sličnosti kroničnog rinitisa i sinuitisa te ovih entiteta i astme. Ova saznanja i dosadašnje kliničko iskustvo nalažu potrebu dijagnostičkih postupaka za dokaz bolesti gornjih i donjih dišnih putova bez obzira na to da li bolesnik afirmira simptome rinitisa ili astme. U skladu s time u većine bolesnika maksimalni terapijski učinak postići će se tek liječenjem bolesti na obje razine dišnog sustava. Suvremeno liječenje temelji se na primjeni učinkovite protuupalne terapije na obje razine, poglavito intranazalnih i inhalacijskih kortikosteroida te antileukotrijena. U dobro definiranim podskupinama bolesnika specifična imunoterapija (SIT) te primjena anti-IgE-protutijela mogu biti optimalna terapijska mjera. Poznavanje kompleksne patofiziološke povezanosti gornjih i donjih dišnih putova pruža prostor za razvoj novih lijekova čiji bi se učinak temeljio na modificiranju interakcije ciljnih organa, sluznice nosa i dišnih putova i koštane srži.The one-airway concept is based on strong epidemiological links, similar genetic and environmental risk factors and the fact that allergic rhinitis is a direct risk factor for asthma development. The immunopathology of asthma and rhinitis, the main components of this syndrome, is very similar and there are also numerous histopathological proofs of similarity between chronic rhinitis and sinusitis, and these entities and asthma. This knowledge and the clinical experience to date require the use of diagnostic procedures to confirm upper and lower respiratory diseases regardless of rhinitis or asthma symptoms. Consequently, maximum therapeutic eff ects in the majority of patients will be achieved only if both respiratory levels are treated. Modern treatment is based on effi cient anti-inflammatory therapy on both levels, in particular with intranasal and inhalation corticosteroids and antileukotrienes. In well defined patient subgroups, specifi c immunotherapy (SIT) and use of anti-IgE antibodies may prove to be an optimal therapy. The knowledge of complex pathophysiological connections between upper and lower airways provides a platform for development of new medicinal products whose effects would be based on modifying interactions between target organs, nasal mucosa and airways and bone marrow