Nasal Pulmonary Interactions
The upper and lower respiratory airways interact in many ways. Important, well-known nasal functions include the filtering, warming, and humidification of inspired air before inhalation into the lungs. Nasal breathing also appears important in aiding oxyg
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James Bartley and Conroy Wong
Keywords
Airway inflammation • Nitric oxide • Carbon dioxide • Unified airway • Asthma • Chronic obstructive airway disease • Bronchiectasis • Allergic rhinitis • Chronic rhinosinusitis
Abbreviations NO CO2 PaO2 FEO2 FECO2
Nitric oxide Carbon dioxide Arterial oxygen levels Fraction of expired oxygen Fraction of expired carbon dioxide
Core Messages
• Physiological, epidemiological, and clinical evidence support an integrated upper and lower respiratory airway or “unified airway” model.
J. Bartley, MB, ChB, FRACS, FFPMANZCA (*) Department of Otolaryngology – Head and Neck Surgery, Counties Manukau District Health Board, 19 Lambie Drive, Manukau, Auckland, New Zealand e-mail: [email protected] C. Wong, MBChB, Dip Obs, FRACP, CCST Department of Respiratory Medicine, Middlemore Hospital, 19 Lambie Drive, Otahuhu, Auckland 1640, New Zealand e-mail: [email protected]
• Nasal breathing improves arterial oxygen concentrations and carbon dioxide excretion from the lungs. • Nasal mucosal inflammation results in lower airway inflammation and vice versa. • Many patients with asthma, chronic obstructive airway disease, and bronchiectasis have significant upper respiratory disease. • Medical management of allergic rhinitis improves asthma. • Nitric oxide from the nose and sinuses may have a role in the sterilization of incoming air and in improving ventilation-perfusion in the lungs. • Nasal resistance is inversely related to end-tidal carbon dioxide levels.
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Introduction
Physiological, epidemiological, and clinical evidence support an integrated upper and lower respiratory airway or “unified airway” model (Krouse et al. 2007; Guilemany et al. 2009; Hurst 2009; Marple 2010). Important, well-known nasal
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_37, © Springer-Verlag Berlin Heidelberg 2013
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functions include the filtering, warming, and humidification of inspired air before inhalation into the lungs. The nose and lungs potentially interact with each other in a number of ways (Fig. 37.1). Nasal mucosal inflammation results in lower airway inflammation and vice versa (Braunstahl et al. 2001a, b). Part of this mechanism is thought to be a generalized inflammatory response that amplifies the response to inflammatory stimuli in other parts of the respiratory tract (Braunstahl et al. 2001a, b). Inflammatory mediators and/or infectious pathogens may also be carried along the respiratory mucosa or along air currents (Hare et al. 2010). Neuronal responses may play a role, although the existence of nasobronchial reflexes remains controversial (Sarin et al. 2006). Nitric oxide (NO) from the nose and sinuses may have a role in the sterilization of incoming air
(Lundberg et al. 1995) and in improving ventilation-perfusion in the lungs (Selimoglu 2005). An inverse relationship between nasal resistance and end-tidal carbon dioxide (CO2) levels has been described (Mertz et al. 1984; Shi et al.
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