Collaboration is Key in Treating Asthma in a Unified Airway, With Heather O'Connell, PA-C

The unified airway is not an idea that lives comfortably inside any single specialty. Pulmonologists manage the lungs. ENTs manage the nose and sinuses. Allergists manage immunologic triggers. And because most providers are trained to think within those silos, patients who sit at the intersection — with rhinitis driving asthma, or sinusitis complicating airway disease — can fall through the cracks between them.

That gap is one 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, addressed directly in her session at the Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Colorado Springs.

"We all siphon off into our own medical specialty and think about the things we're assigned to — but that's just not how the body works," O'Connell said. Closing the gap requires both guideline-level consensus and practical, on-the-ground relationship building within clinical communities.

On the guideline side, the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative — a World Health Organization collaboration — has produced both evidence-based treatment recommendations and explicit calls to action for cross-specialty collaboration in managing unified airway disease.1 The most recent ARIA–EAACI 2024–2025 guidelines continue that work, with updated recommendations on intranasal treatments including a strong recommendation for combining an intranasal antihistamine with an intranasal corticosteroid over monotherapy in patients with moderate-to-severe allergic rhinitis unlikely to respond to a single agent.¹ O'Connell noted that while the guidelines exist and are regularly updated, provider awareness of them — particularly among clinicians who encounter these patients at the margins of their specialty — remains inconsistent.

Her recommendation to APPs navigating these gaps: meet the people in your institution who see different pulmonary conditions, who read chest imaging, who manage rhinitis and nasal polyps. A thoughtful ENT referral for a patient with severe asthma and suspected NERD can be the pivot point in a patient's care — but only if the referral happens. That kind of collaboration, she noted, develops not through guidelines alone but through the kind of cross-specialty networking that conferences like APAP make possible. "The first step is knowledge — knowledge that this is in fact one airway, one organ system," she said.

O’Connell has no disclosures to report.

References

1. Sousa-Pinto B, Vieira RJ, Bousquet J, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA)–EAACI guidelines — 2024–2025 revision: Part I — guidelines on intranasal treatments. Allergy. 2025. doi:10.1111/all.70131

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.