Asthma is one of the most common chronic illnesses in childhood with increase hospitalization rates. Delay in diagnosis or appropriate treatment results in morbidity and complications.

Asthma is associated with inflammation in the lower airways, and the same inflammation might involve the sinuses in parallel fashion ,  so asthma is a  significant factor in the development of rhinosinusiti .   Based on criteria chosen for evaluation of  the radiological changes , about  30-70% of patients with asthma have abnormal sinus X-rays.The sinonasal involvement is significantly greater in the patients with sever asthma than in those with mild-to-moderate asthma. The signs and symptoms of sinusitis overlap with asthma, and also sinusitis play as causal role in creating recalcitrant asthma.

In patients with asthma , sinus radiographs usually do not provide definitive diagnostic information because these patients have an increased frequency of abnormal sinus radiograph , and CT scan imaging of sinus is helpful in establishing the diagnosis of sinusitis.

The diagnosis and  treatment of sinusitis is essential to the care patient with asthma because as we mentioned above sinusitis create recalcitrant asthma, and aggressive treatment of sinusitis decrease medication requirements to control concomitant asthmatic symptoms. In addition to antimicrobial therapy , Endoscopic sinus surgery (ESS) is very effective in asthmatic patients with chronic rhinossinusitis, and ESS can play a significant role in the clinical improvement of asthmatic patients.

We conclude in patients with difficult to control asthma and history of chronic nasal congestion, sinusitis should be considered and patients must be evaluated with CT scan  imaging of sinus.