In their article, Amorim et al. [1] demonstrate, with a cross-sectional study in adult patients with moderate-severe asthma, a convincing association between nasal and sputum eosinophilia and a link between the former and the bronchodilator response, i.e. post-salbutamol forced expiratory volume in 1 s [FEV). These results are in agreement with recent studies that showed strong similarities in tissue inflammatory changes in asthma and rhinitis, further supporting the concept that upper and lower airways should be considered a unique entity influenced by common physiologic processes [2,3]. The authors suggest that the evaluation of upper airway inflammation may reflect and provide an additional insight into the lower airway involvement and propose evaluation of nasal eosinophilia as a surrogate for sputum analysis in these patients. The possible clinical relevance of their findings is also reinforced by the demonstration that the increase in the bronchodilator response was associated with an increase in the odds of nasal eosinophilia. The complex relationship between lower airway eosinophilic inflammation and expiratory flow limitation or bronchial hyperresponsiveness is still unclear [4].
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