Objectives Disorders in the upper and lower airways are linked epidemiologically, pathogenetically and therapeutically. In this study we compared the occurrence of symptoms of upper airway diseases and critical dimensions of the upper airways in children suffering from asthma and age and sex-matched controls.

Methods The study group comprised 27 children with asthma (m/f = 13/14 age = 4.2). The control group included 28 children recruited from 5 kindergartens (m/f = 11/17, age = 4.2). They underwent ENT and pulmonary examinations. Their parents completed questionnaires including VAS-scales, about upper and lower airway symptoms. Acoustic rhinometry, skin prick test and X-rays of the epipharynx were performed.

Results The asthmatics had significantly higher scores than the controls on nasal obstruction, mouth breathing, sleep apneas, rhinorrhea, sneezing, itching, and incidence of colds than the controls. There were no differences in minimal cross sectional areas or volumes in the anterior 5.2 cm of the nose. The average A/N index, a parameter indicating the space for air passage through the epipharynx, was significantly smaller in children suffering from asthma than in the controls.

Conclusion Thus, children with asthma appear to have an increased incidence of symptoms of rhinitis and upper airway obstruction than controls. The site of obstruction appears to be the epipharynx. Considering the importance of nasal breathing for the well-being of the lungs, restrictions in the upper airways for the development of childhood asthma cannot be excluded, and should be further investigated.