Mecanismos de la conexión nariz-pulmón Mechanisms of nose-lung connection

espanolLa via respiratoria, de la nariz al pulmon, actua como un sincicio anatomo -funcional con su correlato fisiopatologico. Desde tiempos remotos los autores estudiaron los mecanismos de conexion entre la via respiratoria superior e inferior que pudiera explicar la elevada coincidencia en la prevalencia de sus respectivas patologias. Algunos de esos mecanismos no se han podido demostrar fehacientemente y las investigaciones muestran resultados contradictorios. Otros responden a determinados fenotipos como el de la relacion entre rinitis y asma alergicas, el modelo mas estudiado, en el que un fenomeno inflamatorio mediado a traves del torrente circulatorio es el mas aceptado. No obstante los fenotipos de enfermedad respiratoria no alergica y el de la patologia mediada por IgE local en nariz y bronquios, no tienen una conexion absolutamente resuelta por las investigaciones. En esta revision discutiremos los distintos mecanismos de interaccion nariz pulmon que por sus caracteristicas anatomicas, fisiologicas y fisiopatologicas avalan la hipotesis de “una via aerea unica, una unica enfermedad” aceptada en la actualidad por la mayoria de los autores EnglishThe airway, from the nose to the lung, may be accepted as an anatomo-functional unit with its physiopathological correlate. From a long time ago the authors studied the mechanisms of connection between the upper and lower airway that could explain the high coincidence in the prevalence of their respective pathologies. Some of these mechanisms have not been proven conclusively and the research shows contradictory results. Others respond to certain phenotypes such as the relationship between rhinitis and allergic asthma, the most studied model, in which an inflammatory phenomenon mediated through the bloodstream is the most accepted. However the knowledge of phenotypes of non-allergic respiratory disease and the pathology mediated by local IgE in the nose and bronchi, they do not have a connection mechanisms completely determined by the investigations. In this review we will discuss the different mechanisms of nasal lung interaction that support its anatomical, physiological and pathophysiological characteristics responsible for "one airway, one disease" currently accepted by most authors.