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Nonallergic Rhinopathies and Lower Airway Syndromes: Comorbid 

Nonallergic Rhinopathies and Lower Airway Syndromes: Comorbid
Nonallergic Rhinopathies and Lower Airway Syndromes: Comorbid

James N. Baraniuk

, Michael S. Blaiss

, and Debendra Pattanaik

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date: 15 April 2021

Nonallergic rhinitis is a heterogeneous disease consisting of wide variety of entities that present with persistent nasal symptoms. “United airways” has become a slogan verging on dogma. The concept gained momentum with the realization that the unifying atopic pathophysiology of the nose and tracheobronchial tree lead to coexistent allergic rhinitis and allergic asthma, respectively. Including nonallergic mechanisms and the differential diagnosis of comorbid rhinitides with reversible and irreversible lower airway obstructive entities is more problematic. Although the nose and foregut-derived tracheobronchial tree have distinct embryonic origins, they share exposure to air, pseudostratified epithelium with extensive submucosal glands, common elements of the innate and acquired mucosal immune systems, and extensive nociceptive and autonomic nervous system sensors and controls. Mechanisms affecting both anatomic sites are likely to develop comorbid disease. Anatomic differences contribute to discrete pathologic conditions, as allowed by the bony box of the nasal cavity versus the cartilaginous walls and elastic alveolar interstitial tethers for bronchi and bronchioles. The diverse pathologic states of the nasal mucosa and their relationships with bronchial hyperresponsiveness are the focus of the remainder of this discussion.

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