100197 - Upper and Lower Airway Diseases: Current Phenotypes and Integrated Treatment Approaches

The connection between upper and lower airway diseases has been studied for decades. This abstract highlights the results of our recent scoping review [1] which mapped recent literature on treatments with beneficial effects across all airway levels.

The scientific database PubMed was searched for relevant articles in the 2020-2025 timeframe.  351 articles were identified. After duplicate removal and screening based on predefined criteria, 26 articles were included. Using a standardized data extraction form, the data were selected, analyzed and published in the form of a review article.

Of the 26 included articles, 42.3% were randomized controlled trials, 19.23% were observational studies, 30.76% were case reports and 7.69% were case series. Three main clinical association patterns were identified: asthma + allergic rhinitis (26.92% of included articles), asthma + chronic rhinosinusitis with or without nasal polyps (76.92%) and asthma + nasal polyps + NSAID-exacerbated respiratory disease (15.38%). Non-respiratory comorbidities reported were atopic dermatitis (7.69%), secretory otitis media (7.69%) and eosinophilic otitis media (11.53%). Integrated treatments were categorized as biologic and non-biologic approaches. Biologic approaches included the use of dupilumab (38.46%), benralizumab (26.92%), omalizumab (7.69%), tezepelumab (15.38%), reslizumab (3.84%) and mepolizumab (11.53%). Of the non-biologic approaches, nasal saline irrigation (3.84%), allergen immunotherapy (11.53%) and endoscopic sinus surgery (7.69%) were included. In most cases, there appears to be a shared systemic inflammatory mechanism underlying these phenotypes. This likely reflects an underlying type 2 inflammatory endotype, which can lead to several diseases affecting different organ systems. When one level of the airway is affected, the other may follow. This supports the hypothesis that treatments targeting the systemic abnormality can improve outcomes on multiple levels.

The modern literature reports several airway disease comorbidities, while suggesting that integrated treatment may provide multi-system clinical benefits.

Reference: Alexandru, V.; Manole, A.; Groza, L.S.; Manole, F. United Airway Disease: An Evolving Concept? A Scoping Review of the Modern Literature on Integrated Treatment Approaches. Life 2026, 16, 220. https://doi.org/10.3390/life16020220