Long‐term results of endoscopic sinus surgery–oriented treatment for chronic rhinosinusitis with asthma

Chen, Fenghong; Zuo, Kejun; Guo, Yubiao; Li, Zhiping; Xu, Geng; Xu, Rui; Shi, Jianbo

doi:10.1002/lary.24196

Cited by 47 publications

(27 citation statements)

References 23 publications

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“…Chen et al previously examined ACT outcomes after ESS. They demonstrated improvement in ACT categorization of asthma control, but failed to show improvement in mean postoperative ACT scores.…”

Section: Discussionmentioning

confidence: 99%

Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis

Schlosser

Smith

Mace

et al. 2016

Allergy

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Background Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality-of-life (QOL) and asthma control using validated outcome metrics. Methods Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini-Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study. Results Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ (0.5 [SD±1.1], 95%CI: 0.2–0.7; p=0.002) and ACT scores (1.3 [±4.1], 95%CI: 0.2–2.4; p=0.025). Uncontrolled baseline asthma (ACT<20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (≥0.5 points) and 50% of the time for ACT scores (≥3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (p=0.045) and chronic obstructive pulmonary disease (COPD; p=0.015). Adjusted baseline ACT scores were worse in patients with COPD (p=0.004). Covariates associated with changes in miniAQLQ scores after ESS were preoperative corticosteroid dependency (p=0.011) and change in total SNOT-22 score (p=0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (p=0.016). Conclusions Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes.

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Section: Discussionmentioning

confidence: 99%

Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis

Schlosser

Smith

Mace

et al. 2016

Allergy

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“…Some studies have shown improvements in asthma control following either surgery or medical CRS treatment . Among 17 steroid‐dependent patients with difficult asthma, surgery for CRS and nasal polyposis reduced airflow obstruction, and nine patients could be weaned off oral corticosteroids completely .…”

Section: Does Treatment Of Comorbidities Improve Difficult Asthma?mentioning

confidence: 99%

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Tay

Hew

2017

Allergy

125

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The care of patients with difficult-to-control asthma ("difficult asthma") is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality.Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as "treatable traits" in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.

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“…Most published studies are of a retrospective nature, [1,8,21,22] or do not include a non-surgical control group [2,3,7,9,17,18].…”

Section: Limitationsmentioning

confidence: 99%

“…Both issues pose significant problems for the validity of the research: retrospective studies, by nature, are at risk of various sorts of bias. Many articles (although not all) report symptomatic relief of asthma following sinonasal surgery [1][2][3][4][7][8][9]. However, without a control group with similar baseline characteristics to compare them with, it is impossible to determine whether this subjective relief might be due to the placebo effect or just an expression of improved quality of life (QoL) due to improved nasal symptoms.…”

Section: Introductionmentioning

confidence: 95%

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Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps

Bruin

Hage

Zaag-Loonen

et al. 2015

Eur Arch Otorhinolaryngol

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The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

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Long‐term results of endoscopic sinus surgery–oriented treatment for chronic rhinosinusitis with asthma

Abstract: FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable.

Cited by 47 publications

References 23 publications

Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis

Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps

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