Improving Patient and Clinician Education on the Unified Airway

One of the practical challenges of the unified airway framework is that patients don't come in thinking about it. A patient presenting to pulmonology with poorly controlled asthma has been living with their lungs as the problem. A patient who has never connected their rhinitis to their wheeze needs someone to make that case — clearly, concisely, and in a way that motivates action.

For Heather O'Connell, PA-C, MS, physician assistant and certified asthma educator at Arizona Asthma and Allergy Institute in Phoenix, Arizona, and President-Elect of the Association of Physician Assistants in Allergy, Asthma, and Immunology, that patient conversation is one of the most important things that happens in a clinic visit for unified airway disease. HCPLive caught up with O’Connell during the Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Colorado Springs to learn more.

"It is a sell to the patient sometimes," she acknowledged — more so when a patient presents to pulmonology without having previously thought about allergies or sinus disease, and less so when a patient in an allergy clinic already has rhinitis symptoms they recognize as burdensome.

Her go-to tool for making the connection real: the work of Gert-Jan Braunstahl, whose 2001 study at Erasmus University Medical Center in Rotterdam demonstrated that nasal allergen challenge in patients with seasonal allergic rhinitis — but without asthma — produced bronchial inflammation not present before the challenge. In the reciprocal experiment, allergen delivered into the bronchus produced nasal inflammation.1 "That can kind of click with a patient who hasn't really gotten it," O'Connell said. "If they're immunologically connected that way — okay, that makes sense."

From there, the clinical approach is structured and outcome-driven. O'Connell described prescribing treatments — including over-the-counter options — as formal recommendations rather than suggestions, then setting a defined window of 6 weeks for the patient to return for objective reassessment: FEV₁, FeNO, and albuterol use frequency. Giving a patient a prescription, even for an intranasal corticosteroid, signals clinical seriousness in a way that a verbal recommendation does not. And measuring outcomes at follow-up gives both patient and provider evidence of whether treating the upper airway is moving the needle on asthma control. "Most of the time it does," she said.

On the question of whether APPs bring particular advantages to this work, O'Connell offered 2 observations. The first is practical: many APPs entered pulmonology or allergy from primary care or general medicine backgrounds, which means they already think beyond single-organ disease. The second is relational: patients frequently describe APPs as approachable and communicative in ways that facilitate the kind of extended education these conversations require.

"I hear it from patients all the time — I love seeing a PA, I love seeing an NP, because I feel like you understand what I'm saying," she said. Whether that reflects training, time, or something more individual, it translates into clinical utility in a disease that demands patient engagement to manage well.

O’Connell had no relevant disclosures to report.

References

1. Braunstahl GJ, Overbeek SE, Kleinjan A, Prins JB, Hoogsteden HC, Fokkens WJ. Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol. 2001;107(3):469–476. doi:10.1067/mai.2001.113046

2. O'Connell H. Treating allergic asthma outside of the airways: the United Airway. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAP 2026); Las Vegas, NV