Effect of functional endoscopic sinus surgery on bronchial asthma outcomes

Background: For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationsh ips have been proposed but not proved. To date, limited evidence exists sug gesting that asthma improves after surgical correction of rhinosinusitis. Objective: To determine whether asthma control improved after first-lime fu nctional endoscopic sinus surgery (FESS). Patients and Methods: A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medica lly refractory chronic rhinosinusitis. Patients received comprehensive asth ma care before and after FESS (mean, 19.3 and 33.1 months, respectively). O utcomes analyzed included pre- and post-FESS individual and group mean asth ma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice af filiated with a medical school. The surgical procedure was performed at a t ertiary care teaching hospital by a single ear, nose, and throat surgeon (R .L.). Results: Following FESS, there was no statistically significant change in g roup mean asthma symptom scores, asthma medication use scores, pulmonary fu nction test results, and the number of emergency department visits or hospi tal admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). Conclusions: The data do not support the hypothesis that first-time FESS fo r medically refractory chronic rhinosinusitis in adult patients with chroni c asthma leads to reduced postoperative asthma symptoms or asthma medicatio n use or improved pulmonary function. Based on this limited study, a reexam ination of the benefits of sinus surgery to coexisting asthma is in order.