Patients who have chronic sinus disease and allergic rhinitis may face a substantially higher risk of developing asthma, highlighting the growing importance of a “unified airway” approach to respiratory health.
That claim comes from research outlined in the paper, “Allergic Rhinitis Amplifies Asthma Risk in Patients With Chronic Rhinosinusitis: A Large-Scale Retrospective Cohort Analysis,” recently published in the International Forum of Allergy and Rhinology.
The large, retrospective cohort study found that individuals with chronic rhinosinusitis (CRS) were significantly more likely to develop asthma than those without the condition. Researchers conducted the study using data from the TriNetX U.S. Collaborative Network (an electronic health record database encompassing more than 100 million patients,), assessing patient records between 2009 and 2019.
Analysis revealed that CRS alone increased the likelihood of new‑onset asthma by roughly 40% within one year, with elevated risk persisting over time. The most striking finding emerged when allergic rhinitis (AR) — a common condition that causes nasal inflammation due to allergens — was present alongside CRS, researchers reported. Patients with both conditions experienced a substantially amplified risk, with asthma incidence increasing by nearly 70% compared to CRS alone at one year and remaining elevated at two and five years.
The paper’s authors noted that patients with CRS and AR also faced more than double the risk of asthma exacerbations, underscoring not only a higher chance of developing asthma but also a greater likelihood of more severe disease.
Investigators used propensity score matching to control for differences in demographics and underlying health conditions, strengthening the reliability of the findings.
According to the study’s results, asthma rates among CRS patients climbed from 3.25% at one year to nearly 9% at five years, significantly higher than rates observed in patients without CRS. Researchers noted this reinforces the concept that the upper and lower airways function as a connected system and inflammation in the nose and sinuses may spread or influence the lungs, leading to increased vulnerability to asthma.
Authors said the study also highlights shared biological mechanisms, including type 2 (T2) inflammation, eosinophilic immune responses and epithelial barrier dysfunction, which link CRS, AR and asthma within a common disease pathway.
Researchers said the increased risk of asthma appeared to be most pronounced in the early years following a CRS diagnosis, with risk levels stabilizing over time. They believe this may reflect both biological progression and heightened clinical detection as patients interact with healthcare systems more frequently.
Based on the findings, researchers urged clinicians to take a more proactive approach when managing patients with chronic sinus disease, especially when AR is present. They recommended:
- Routine screening for asthma in patients with CRS
- Greater attention to coexisting allergic conditions
- Potential benefits of targeted upper airway treatments
Although the study did not directly test treatment strategies, the authors noted prior research has shown that managing allergic rhinitis through therapies such as immunotherapy or intranasal steroids can improve respiratory outcomes and may even reduce asthma risk.
