The effect of endoscopic sinus surgery on asthma: Management of patients with chronic rhinosinusitis, nasal polyposis, and asthma

We attempted to determine the efficacy of endoscopic sinus surgery in adult patients with asthma and chronic rhinosinusitis or nasal polyposis. Fifty asthmatic patients from 17 to 74 years of age with a history of either chro nic rhinosinusitis or nasal polyposis were examined. Sinonasal disease was confirmed endoscopically and with computerized tomography, and all had fail ed aggressive medical management of their sinonasal disease before undergoi ng endoscopic sinus surgery performed by the same surgeon in all cases. The following were compared for 12 months: preoperative and postoperative over all asthma control, peak flow measurements, asthma medication requirements, including the use of oral steroids, and hospitalizations for asthma. Twent y patients felt that their asthma control had improved postoperatively. Twe nty per cent used less steroid inhaler, and 28% less bronchodilator inhaler Of those 23 patients measuring peak flows, seven achieved higher levels an d seven noted fewer dips and swings. Significant reductions in oral steroid requirements (p < 0.001) and hospitalization for asthma (p < 0.025) were a lso recorded postoperatively. Irrespective of whether the patient had chron ic rhinosinusitis or nasal polyposis, both groups improved postoperatively. The commonest symptoms experienced by the group as whole and by the nasal polyposis patients were hyposmia and nasal obstruction. Postnasal discharge and headache were mor-e important in the chronic rhinosinusitis group; Mea n visual analog scores improved for all symptoms; in particular for nasal o bstruction and sense of smell. Aggressive management of sinonasal pathology can improve asthma status. No major differences were recorded for outcomes when comparing patients with chronic rhinosinusitis or nasal polyposis; in particular there was no evidence for a worsening of asthma after nasal pol ypectomy.