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United Airway Disease

I have been on a quest to learn a bit more about the United Airway Disease concept. I am trying to learn more about the connection between my lungs and my nose. It was originally thought that my sinus inflammation was intermittent, connected to allergen exposure and limited. It looks like that may be changing, my ENT suggested that we may need to start thinking about my disease not just being in my lungs. Have you heard about this concept? Any experience with it? I would love to hear if you have been dealing with this?

Did you know that there is a concept called “United Airway Disease”?

Here are few things to know:

  • The concept is still in development and not all is yet understood.
  • This is treated by both lung specialists: (Pulmonologist/Respirologist and ENT and encompasses both allergic rhinitis and asthma, that are considered to be the same disease 1. They are considered to be the same due to the similar inflammatory presentation.
  • Allergic Rhinitis is a disease of the nasal mucous membranes, induced by an IgE-dependent inflammation after the exposure to allergens.4
  • The respiratory tree is divided into upper and lower tract. The upper airway consists of the nose, pharynx, and larynx. The lower respiratory tract consist of consist of the trachea, bronchioles, alveolar duct and alveoli.1
  • The nose is thought to filter out foreign substances from the lower tract.2
  • The lower airways also filter out inhaled particles that are trapped and cleared by mucous. (sputum, fun fact!)
  • Upper airway obstruction is linked to vasodilation and edema. Lower airway obstruction is connected to smooth muscle function, similar to bronchospasm.

Concepts of United Airway Disease

  • Changes in upper and lower airways can lead to more systemic responses.
  • The nose is usually the first site of exposure and researchers hypothesize that nasal mucosa may have a protective mode that minimizes remodeling and cellular regeneration.3
  • Remodeling tends to be more significant in the lower airways than the upper airways. An integrated diagnostic and therapeutic approach is needed for more holistic disease control.

Treatment for United Airway Disease?

  • Avoiding allergens, this may also involve testing to identify allergens.
  • Typically oral or intranasal antihistamines and nasal corticosteroids.5

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Remodelling A, Castagnoli R, Denicolò CF, Rossini L, Marseglia A, Marseglia GL. The Nose and the Lung: United Airway Disease?. Front Pediatr. 2017;5:44. Published 2017 Mar 3.
  2. The EAACI Global Atlas of Allergic Rhinitis and Chronic Rhinosinusitis. (2016). Available from:
  3. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol (2010) 125:S73–80.10.1016
  4. Licari A, Ciprandi G, Marseglia A, Castagnoli R, Barberi S, Caimmi S, et al. Current recommendations and emerging options for the treatment of allergic rhinitis. Expert Rev Clin Immunol (2014) 10:1337–47.10.1586
  5. Duse M, Caminiti S, Zicari AM. Rhinosinusitis: prevention strategies. Pediatr Allergy Immunol (2007) 18:71–4.10.1111


  • John Bottrell, RRT moderator
    10 months ago

    Nice article, Dia. Yes, I have heard of this. Anything that triggers upper airway disease may be transferred to the lower airways too, inflammation of both. It’s kind of a neat concept, and hopefully will lead to better control of your symptoms. John. Site Moderator.

  • Shellzoo
    10 months ago

    I heard about it from the PA at the allergist office. I have had allergies, sinusitis, nasal issues for years. At one visit I was told they are all related and a happy airway needs a happy nose. I use Flonase twice a day and take allergy meds to keep my nose happy.

  • Leon Lebowitz, RRT moderator
    10 months ago

    Hi Shellzoo and thanks for responding to this article by Dia. Glad this resonated so clearly with you. Leon (site moderator)

  • Leon Lebowitz, RRT moderator
    10 months ago

    Hi again, Shellzoo. I’m sure Dia will be extremely pleased to read your comment. Leon (site moderator)

  • Shellzoo
    10 months ago

    I really enjoy Dia’s articles.

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