engleski

Introduction to EAACI ENT Section Task Force Report "Diagnostic tools in rhinology"

There are several reasons for accurate investigation of upper airways disorders. The first is that such problems impact very significantly upon patients’ quality of life and that well directed treatment can ameliorate the impairment of quality of life. The second is that some of these disorders are severe with significant morbidity and even mortality, and that presentation often occurs in the upper airway. Early diagnosis and effective management can prevent serious consequences, like in Wegener's granulomatosis. The third reason relates to the fact that upper respiratory tract problems exacerbate lower respiratory symptoms and may extend to involve the lower respiratory tract. The nose is an air conditioner ; filtering, warming and humidifying over 10.000 litres of air daily before it progresses to the lungs. The nasal passages and associated structures bear the brunt of environmental contact being the first site of allergen, microbial and particle deposition. As a consequence the upper airway is the location of a highly developed innate and adaptive immune system. Effective mucociliary clearance is vital for respiratory health as evidenced by the effects of defects such as primary ciliary dyskinesia (PCD) and cystic fibrosis. Lower airways disease is often preceded by nasal and sinus disease leading to a window of opportunity for early diagnosis and possibly prevention of severe complications. For example measurement of nasal nitric oxide is simple and quick and very low levels can alert the physician to the possibility of PCD before major lung damage is sustained, thus allowing the benefit of early physiotherapy. Inflammatory airways diseases usually start in the nose: This is not only true of allergic and non- allergic rhinitis in older children and adults which can progress to asthma, but also of respiratory occupational disease, and of rhinosinusitis which can be the presentation of Wegener’s granulomatosis or Churg Strauss syndrome and is also associated with bronchiectasis. The ability to recognize and accurately diagnose nasal disease should be a part of the armamentarium of all allergists, chest physicians and paediatricians as well as ENT surgeons. In addition, the nose provides an ideal area for investigation of disease mechanisms. It has given us insights into the pathogenesis of allergic disease and of changes during pharmaco-and immune therapy. Now investigations into other forms of inflammatory and non-inflammatory nose and sinus disease are ongoing with possibly new forms of therapy as a result. The ENT section of European Academy of Allergology and Clinical Immunology has recognized the need of a systematic approach to review diagnostic tools in rhinology, and formed a Task Force Group, that has created a document to be published in the near future.

Upper airways; lower respiratory tract; nose; rhinology; diagnostic tools

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