An Overview of Sinusitis in COPD

You are at an increased risk of developing sinusitis (sinus inflammation or infection) if you have chronic obstructive pulmonary disease (COPD). And breathing problems of COPD can worsen when your sinuses are inflamed. Your healthcare provider can diagnose sinusitis with a physical examination and may give you instructions to help you recognize a recurrence.

Medications can alleviate your sinusitis, and you may also need treatment to help mitigate the effects on your COPD.

Symptoms

Typically, sinusitis causes sinus congestion, runny nose, sore throat, headaches, sinus pressure, cough, phlegm production, fatigue, trouble sleeping, and/or fevers.

These issues can have an impact in and of themselves, but have a compounding effect when paired with COPD symptoms—so much so, in some cases, that you may overlook the possibility of having sinusitis and attribute your symptoms to COPD alone.

For example:

• COPD is often characterized by excess mucus production and difficulty clearing it from the airways. The additional phlegm produced from sinusitis only adds to this.
• People with COPD typically have a persistent, daily cough, which often leaves them fatigued. When sinusitis is also present, both cough and fatigue can worsen.
• Congestion associated with sinusitis can make it even more difficult to breathe, leaving you short of breath or gasping for air.

Sinusitis worsens pulmonary function whether you have COPD or not, but the effect is obviously more profound in people who have existing respiratory issues.

Sinusitis is also more likely to recur or linger if you have COPD. This is often described as chronic sinusitis.

Complications

An episode of sinusitis usually starts as a mild infection or inflammation that just affects the sinuses. But, with COPD, it can spread to the lower airways, leading to bronchitis or pneumonia. The effects can include hypoxia (low oxygen in the body's tissues) or hypoxemia (low blood oxygen).

Over time, recurrent lung inflammation due to sinusitis or lung infections can actually damage your lungs, worsening your COPD and causing a substantial decline in your ability to function.

Sinusitis can make COPD worse to the point that it increases the risk of COPD-related hospitalization and re-admission.

Causes

There are a number of risk factors that COPD and sinusitis have in common, and the conditions can also interact to worsen one another.

In addition to airflow obstruction, COPD is associated with impaired immunity as well as difficulty clearing infections, both of which increase your risk of developing sinusitis. Shared triggers are also important to consider.

Sinusitis is sinus (upper airway) inflammation, while COPD is damage and inflammation of the lungs (lower airways).

The irritants that can induce inflammation in your lower airways and trigger COPD (e.g., dust particles, infectious organisms) can do the same in your sinuses. This is often described as the nasal-bronchial effect, in which both airways react to a trigger at the same time, each producing symptoms and effects that correspond with their locations.

Excessive airway inflammation in response to irritants is common in COPD, and this airway hyperreactivity makes people with COPD more prone to chronic sinusitis. The airways can become inflamed and may constrict in response to mild triggers, making it hard for air to pass through. These triggers can then become trapped in the inflamed airways, creating a self-perpetuating cycle.

Diagnosis

When your COPD symptoms act up, your healthcare provider will take a careful history and do a physical examination. Identifying an episode of sinusitis when you have COPD may also require diagnostic testing.

Sinusitis can be acute (just a brief infection) or chronic (frequently recurring or a lingering infection). It can be difficult to distinguish acute sinusitis from a COPD exacerbation or chronic sinusitis from your COPD. This is because you might already have some chronic symptoms of COPD—like coughing, dry throat, phlegm, trouble sleeping, and fatigue—that mask the effects of sinusitis.

Physical Examination

Your medical team will check your temperature, as a fever is a sign of infection.

Your healthcare provider will listen to your breath sounds and will look at your muscles to see if you are struggling to breathe. (Advanced COPD or an exacerbation can cause wheezing and necessitate your use of accessory muscles—those of your upper chest, shoulders, and neck—as you breathe.)

Your healthcare provider will also look at the back of your throat, as it can be inflamed, red, or show signs of pus when you have sinusitis. They will tap on your sinuses to check for tenderness or fullness as well.

Testing

With sinusitis, a sample of the saliva in the back of your throat can be tested in a laboratory to see if there is any evidence of an infectious organism. A negative result (no organisms growing), however, is not necessarily a sign that you don't have a sinus infection.

You might also have a blood test, which may show elevated white blood cells if you have sinusitis. And a sinus X-ray may show fluid or inflammation of the sinuses, which are signs of sinusitis.

Treatment

There are also a few lifestyle changes you can make at home to help alleviate your sinusitis and the associated worsening of your COPD.

• Nutrition and hydration: Be sure to eat healthily and drink plenty of water if you aren't doing that already.
• Avoid irritants: This includes cigarettes (smoking or inhaling second-hand smoke) and other allergens that tend to make your COPD act up.
• Humidifier: Consider using a humidifier to reduce any irritants or allergens circulating in the air. If you notice an improvement, then it's a good idea to continue to use it. Remember to clean it out and change the water as directed.
• Irrigation: You can irrigate your nasal passages with a neti pot when you have episodes of sinusitis.

Your healthcare provider can also recommend medications to treat your sinus infections. These may include:

• Decongestants
• Antibiotics (if you have a bacterial infection)
• Antipyretics (medications that lower a fever)
• Pain medications (if you have headaches or sinus tenderness)
• Steroids (to reduce inflammation)

You may also need to use oxygen treatment if your respiratory function is severely declining.

In some cases, you may need to be hospitalized if a bout of sinusitis causes a major decline in your respiratory function due to your COPD.

A Word From Verywell

Sinusitis and COPD often go hand-in-hand. If you have COPD, it helps to try to learn to recognize recurrent sinusitis so you can get treated and prevent sinusitis from worsening your COPD.