Hello. Thank you for asking at HCM. I went through your wife s history and would like to make following suggestions to her: 1. As an Allergist-Immunologist, I would suggest her to her allergy testing done for air-borne allergens, especially house dust mite, common molds & pollens in your area, cockroach proteins and animal dander (if you have pets). This will help her to identify the substances causing asthmatic and nasal symptoms to her. Depending upon the results, an Allergist-Immunologist may prescribe her allergen specific immunotherapy which will train her immune system to modify response towards these substances and will improve her allergy symptoms in a long run. 2. Both nose airways and lungs airways are in continuum from inside. So it is important to treat and control nose symptoms to prevent asthma symptoms. 3. Usually I prescribe such patients daily levocetirizine and montelukast. Also, I would prescribe her salbutamol or levosalbutamol inhaler which is to be used for asthma symptoms on as-and-when-needed basis. 4. Regarding nasal sprays, it depends upon what kind of spray she has used. Sometimes prolonged use of decongestant sprays (used to open nose) can lead to even worsening of nasal congestion and in such cases, I would suggest her to use intranasal corticosteroid spray for at least 2-4 weeks. 5. Personally I would suggest her regular breathing exercises and a diet rich in vitamins and minerals (adequate amounts of green leafy vegetables, fruits, sprouts, etc) which will improve respectively her lung capacity and immune system in longer run. 6. Please avoid exposure to dusts, smokes and air pollution to her as much as possible. 7. Regarding need of surgery, it can be best decided by an ENT surgeon rather than an Allergist-Immunologist. Hence I would suggest you to consult an ENT surgeon for this concern. Hope above suggestions will be helpful to her. Should you have any further query, please feel free to ask at HCM. Wish her the best of the health. Thank you & Regards.