Rhinitis and the unified airway

Compartmentalisation of chronic inflammation to one part of the respiratory tract is the exception rather than the rule. Aspiration of inflammatory secretions, as a causal link between upper airway and lower airway disease, is unlikely in a neurologically intact patient. Good evidence suggests the same inflammatory process occurs in both the upper and lower airways. Multifaceted concurrent therapy is the key to obtaining rapid symptom control. Surgery such as turbinate reduction should be used as an adjunct in therapy, and not as a treatment of last resort. Immunotherapy started early may alter the course of rhinitis and asthma, halting the 'allergic march'.