Raising awareness of upper airway diseases: Overview of management and prevention strategies WANG De-yun *

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1 Med J Chin PLA, Vol. 42, No. 10, October 1, ( ) (ARIA ) (GA2LEN) - (EP3OS ) (2016) Allergy Therapeutics and Clinical Risk Management Military Medical Research (2007 ) (2012 ) [ ] ( ) ( ) ( ) - 10~20 ( ) [ ] - [ ] R714 [ ] A [ ] (2017) [DOI] /j.issn Raising awareness of upper airway diseases: Overview of management and prevention strategies WANG De-yun * Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, , Singapore * Corresponding author, entwdy@nus.edu.sg [Abstract] The nose together with the paranasal sinuses is the main part of the upper airway, which is lined with pseudostratified columnar ciliated epithelium. There are several important physiological functions such as conditioning and filtration of the inspired air and the provision of end organ for the sense of smell. Besides the nose also fulfills a physical and immunological barrier as the nasal epithelium is the first site of interaction between the host tissue and foreign invaders, such as viruses, bacteria, [ ] ( ) [ ] entwdy@nus.edu.sg

2 fungi, allergens, and harmful particulates. Hence, nasal diseases such as rhinitis (allergic and infectious) and rhinosinusitis are the most common health problems worldwide, affecting millions of people of all ages. In the past 10 to 20 years, our understanding of the immuno-pathophysiological mechanisms underlying the common nasal diseases has been significantly enhanced by in vivo and in vitro studies. This allows the development of novel therapeutic strategies designed to improve the physiological and immune defense functions of the nose, as well as for other common airway diseases. Since the dynamically external changes of atmosphere, environment (pollution) and susceptible population, we are now facing some of new features on epidemiology and the types of upper airway diseases that require us to in-deep study the diseases through basic and clinical researches, so as to further understand the prevention, diagnosis and treatment of the diseases. [Key words] upper respiratory diseases; nose and paranasal sinus; allergy; infection; treatment; recent advance ( ) ~20 000L [1-2] [3] (>90%) 2 m ( ) ( 1) [4] / - Early life Childhood Adolescence Adult Allergic rhinitis Rhinosinusitis Other diseases Scanning electron microscopic image of the healthy nasal epithelium ( 1500 magnification) Double immunofluorescence staining of nasal epithelium using - -tubulin (for cilia, red) and ZO-1 (tight junction, green) ( 400 magnification) Nasal epithelium Physical barrier Host defense against common pathogens/allergens Immune-modulation Genetic factors Environmental factors 1 - [4] IL-25 IL-33 TSLP Infection/ inflammation Fig. 1 Relationship between the nasal epithelium and common nasal diseases [4] Viruses Bacteria Allergens Fungi 1~2 - [5] 10%~40% [6] % [7] %~15.2% [8] %(4.8%~9.7%) [9] - [10] 20~ ( 2 3)

3 Med J Chin PLA, Vol. 42, No. 10, October 1, Allergic rhinitis Allergens Genetic predisposition Air pollution Changes in lifestyle Foods Drugs Hygiene hypothesis Modification in diet responsible for the diminution of protective nutrient intake Stress Over usage of paracetamol/ antibiotics in early life (Viral rhinosinusitis, common cold, acute upper respiratory infection) Influenza Respiratory syncytial virus Rhinovirus Adenovirus Coronavirus Herpes virus Parainfluenza virus Coxsackie virus (With and without nasal polyps) Ciliary impairment Allergy Asthma Aspirin sensitivity Immuno-compromised state Genetic predisposition Pregnancy and endocrine state Local host factors Environment Biofilm Iatrogenic factors Osteitis Helicobacter pylori and laryngopharyngeal reflux 2 Fig. 2 Common risk factors for acute rhinosinusitis (viral infection), allergic rhinitis, and chronic rhinosinusitis (with and without nasal polyps) (Viral rhinosinusitis, common cold, acute upper respiratory infection) Viral infection Post-viral inflammation Bacterial infection (<5%) Mucosal inflammation Allergic rhinitis Th2-skewed Undetermined due to multifactorial mechanisms Th1-skewed (predominant) Chronic rhinosinusitis (Without nasal polyps) Chronic rhinosinusitis (With nasal polyps) 3 Fig. 3 The common pathophysiological characteristics of nasal mucosal inflammation and common nasal diseases [5] ( 3) 10~20 (mucociliary transport system) [4,11-14] 10 (medicine will move from a

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