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Otolaryngologists Need to Look for Pulmonary Symptoms

James Mims, MD, Wake Forest University School of Medicine, speaks during “Blow-by-Blow: Asthma in the Otolaryngologist’s Office.”

Asthma affects more than 24 million people in the United States, and it is on the rise. With the increased recognition of the unified airway model theory that the entire respiratory system functions as a unit, it makes sense for otolaryngologists to look for asthma symptoms in their patients.

The importance of looking for its symptoms and treating them was explained Sept. 11 in “Blow-by-Blow: Asthma in the Otolaryngologist’s Office.”

“The inflammation that occurs in one area of the respiratory system is often seen in other areas. It is common in various respiratory diseases to have a nasal and sinus component as well as pulmonary component, or a laryngeal component and a pulmonary component. You can point to a multitude of conditions where that is the case,” said session moderator Sarah K. Wise, MD, MS, associate professor and director of otolaryngic allergy at Emory University.

The unified airway model holds that what happens at the upper reaches of the respiratory system—the sinuses, nose, pharynx, and trachea—can affect the system down into the lungs.

“Frequently, when the nose and sinuses are treated in some way, whether that is with medications, surgery, or allergen immunotherapy, the other respiratory aspects may improve,” Dr. Wise said. “The cough gets better, the pulmonary inflammation can improve. Patients generally feel better.”

Presentations in the Miniseminar covered the epidemiology of asthma and its rates of association with common otolaryngology entities, such as allergic rhinitis, sinusitis, laryngeal disorders, and obstructive sleep apnea. Speakers also explained evaluation for asthma, pulmonary function testing, asthma criteria published by the National Heart, Lung, and Blood Institute, and treatments.

“Some otolaryngologists are comfortable treating asthma,” Dr. Wise said. “Treatment of asthma is advocated by other otolaryngology societies, such as the American Academy of Otolaryngic Allergy. However, there are not as many otolaryngologists actively evaluating and treating asthma as potentially could, which is one of the reasons we thought this session could be helpful.”

A key for otolaryngologists is to ask patients about pulmonary symptoms when they complain about runny, itchy noses; nasal congestion; or watery eyes.

“When patients are in the otolaryngologist’s office, they are focused on telling us about their nasal, throat, or laryngeal symptoms,” Dr. Wise said. “However, unless we specifically ask them if they cough, wheeze, or feel tightness in the chest, they may not offer that in their history.

“But frequently, if we take the initiative to ask about those symptoms, they will say, ‘Yes, I have that’ or ‘I had asthma as a child.’ That tips us off to investigate further, to pull out the stethoscope and listen to their lungs.”

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