and Pascal
In 2001, the European Respiratory Society welcomed a Monograph entitled “The Nose and
Lung Diseases” [1] and one of the original Guest Editors, Philippe Godard (1948–2011),
was instrumental in gathering people around the idea that the nose is the most easily
accessible part of the airways.
With this new ERS Monograph we would like to again emphasise the notion within our
chest community that the nose and sinuses belong to the airway tree, and that it is part of
our duty as chest clinicians to think about the upper airways in all our common diseases
and to consider our ENT colleagues as important partners in improving the quality of life
of our patients. The links between the upper and lower airways are numerous, including
anatomical, physiological, triggers and risk factors. The presence of these strong
relationships argues for a constant dialogue between specialists and we hope that the
comprehensive overview presented in the various chapters herein will contribute to
reinforce the willingness of our colleagues to undertake fruitful collaboration in order to
increase our knowledge with the ultimate goal of improving patient care.
The first three chapters cover anatomy, imaging and clinical examination, within the
approach of the “united airways” concept. This approach should consider a pragmatic
understanding of the situation, subject to the constraints of human and financial resources,
leading to the best compromise to establish a clear diagnosis. Mutual understanding
between chest physicians and ENT specialists is the guiding principle. We should
understand the real involvement of the upper airways in all chronic respiratory disorders
and consider them as “morbidities” rather than comorbid conditions.
The association of nasal polyposis and asthma and the complex pathophysiological
landscape is covered by chapters focusing on chronic infection and its potential impact on
immunity, and the perspectives of both ENT and chest physicians. Sino-nasal involvement
in cystic fibrosis and COPD patients requires specific attention, not only as a source of
potential triggering pathways but also as a matter of persistent complaints. The subjective
symptoms, including fatigue, impaired sleep quality, dyspnoea and mucus secretion, should
direct more attention to the upper airways. Risk factors, triggers and other associated
influences are important, but direct causality is often difficult to demonstrate and a strong
Copyright ©ERS 2017. Print ISBN: 978-1-84984-085-9. Online ISBN: 978-1-84984-086-6. Print ISSN: 2312-508X. Online ISSN: 2312-5098.
Correspondence: Pascal Chanez, Respiratory Medicine APHM, INSERM U1067, Aix-Marseille University, 7 rue Scudery, 130007
Marseille, France. E-mail:
Airways Research Laboratory, Ghent University, Ghent, Belgium.
of ENT Diseases, CLINTEC, Karolinska Institute,
Stockholm, Sweden.
de Pneumologie et Addictologie and PhyMedExp, University of Montpellier, INSERM U1046, CNRS
UMR 9214, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France.
Medicine APHM, INSERM U1067,
Aix-Marseille University, Marseille, France. xi
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