inquiry objective: Previous studies have refer toed that aggressive treatment of sinusitis can decrease bronchial hyperresponsiveness (BHR) However.

inquiry objective: Previous studies have refer toed that aggressive treatment of sinusitis can decrease bronchial hyperresponsiveness (BHR) However, there is still too little evidence to draw this conclusion, and the universal remains controversial.

Design: A prospective, open-label study

Setting: University children's hospital allergy and immunology center and radiologic department.

Patients: Sixty-one children with mild asthma and allergic rhinitis participated in the research Forty-one of these 61 children had sinusitis, and the remainder had no sinusitis. Ten matched, nonatopic, healthy children were used as a have charge of group.

Intervention: Children with chronic sinusitis were placed into pair groups. One group was treated with amoxicillin-clavulanate for 6 weeks and then with nasal saline solution irrigation for 6 weeks. For the other dispose the treatment order was revers Children without chronic sinusitis received nasal saline solution irrigation for 12 weeks.

Measurements: Clinical symptoms and signs of sinusitis, FE[Vsub1] and BHR were analyzed in the patients before and after treatment.

Results: The clinical symptoms and signs of sinusitis, on the contrary not FE[V.sub.1], showed a significant improvement after antibiotic treatment. After aggressive treatment for sinusitis, it was originate that the provocative concentration of methacholine causing a 20% fall in FE[Vsub1] of children with mild asthma and sinusitis was significantly higher after treatment.

Conclusion: The comes suggest that every asthmatic patient exigencys to carefully evaluate to determine whether the patient has concomitant sinusitis. Respiratory infections that come together criteria for sinusitis, even if they do not exacerbate asthma, should be treated. It is proposeed that sinusitis should always be kept in mind as a possible inducible factor for BHR and that aggressive treatment of chronic sinusitis is indicated when dealing with an asthmatic patient who point outs an unpredictable response to appropriate treatment. Moreover, the findings of this cogitation provide more evidence for an association between sinusitis and asthma with think highly of to BHR.

explanation words: asthma; bronchial hyperresponsiveness; methacholine challenge test; sinusitis

Abbreviations: BHR = bronchial hyperresponsiveness; P[Csub20] = provocation concentration of methacholine causing a 20% fall in FE[Vsub1]

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Bronchial hyperresponsiveness (BHR) defined as an exaggerated constrictive replication of the airways to a wide variety of stimuli, is caused by means of the characteristic pathologic abnormalities seen in asthma, and BHR clearly plays a central part in the pathophysiology of asthma. (1) It is near in almost all patients with existing symptomatic asthma. (2) The resort to frequently association of asthma and sinusitis has been noted for many years. As many as 80 to 90% of children and adolescents with asthma also have nasal symptoms, and half of all patients with asthma have radiographic evidence of sinusitis. (3) Several studies have described the incidence of chronic sinusitis to be as high as 40 to 60% in children with bronchial asthma. (45) In Taiwan, 104% of children have an asthmatic disease, (6) and half of them also have concomitant sinusitis. (7)

Corren and Rachelefsky (3) give an inkling ofed that inflammation of the upper airway, as from allergic rhinitis or sinusitis, flows in increased bronchoconstriction of the lower airway. In 1870 Kratchmer first intimateed on the basis of an animal prototype that chemical stimulation of upper airway mucosa may induce bronchoconstriction. (8) Bucca et al (9) reported that increased lower airway responsiveness is associated with chronic sinusitis and that BHR improved after sinusitis therapy. Rachelefsky et al (10) showed that aggressive medical treatment of concomitant chronic sinus disease in asthmatic children notably improved the asthmatic symptoms and lung function. Another inquiry (11) involving surgical treatment of chronic sinusitis also showed similar issues These findings suggest that concomitant chronic sinusitis is a precipitating factor for bronchial asthma or lower inflammatory airway diseases. However, there continues to be a poor appreciation of this, and indeed a certain number of doubt as to whether sinusitis does play a causative character in asthma. Whether the pair diseases are linked by a cause-and-effect relationship or as a consequence of pathogenetic events affecting the whole respiratory tract remains unanswered.

It is still unknown whether chronic sinusitis itself induces BHR or plane whether there is a difference in BHR between chronic sinusitis, allergic rhinitis, or other bronchial diseases. rife studies are promising, but as in addition there is insufficient evidence to draw a final conclusion. (1213)

The relationship between upper airway infection and BHR thus remains incompletely investigated. The idea of clarifying the relationship between sinusitis and asthma, together with a meditation of whether aggressive treatment of chronic sinusitis is indicated, is an attractive undivided In this prospective study, the aim was to determine, firstly, whether aggressive treatment of sinusitis can improve the care of asthmatic patients and, secondly whether chronic sinusitis itself induces BHR

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