Table 1.
Trials evaluating the impact of CRS surgical treatment on asthma
| Study (year) | LOE (1a to 5) | Study design | Study groups | Clinical endpoints | Conclusion |
|---|---|---|---|---|---|
| Swierczyńska-Krępa et al65 | 1b | Prospective randomized trial | 1. AIA patients with nasal polyps | 1. Nasal clinical and biochemical parameters | 1. Only patients with AIA had clinically beneficial effects of AD on nasal and bronchial symptoms |
| 2. ATA patients with nasal polyps | 2. Lower airway clinical and biochemical parameters | ||||
| Ehnhage et al36 | 1b | Prospective randomized trial | CRSwNP and asthma, after FESS | 1. Nasal symptoms improvement | 1. FESS improve nasal and lower airway symptoms |
| Group 1, FPND 400 μg | 2. Polyp score | 2. No significant differences between FPND group and placebo regarding nasal and lower airway symptoms | |||
| Group 2, placebo | 3. Lower airway symptoms improvement | 3. Potential benefits of FPND were probably overshadowed by FESS | |||
| Ragab et al64 | 1b | Prospective randomized trial | Surgical group, CRSsNP/CRSwNP | 1. Asthma symptoms and control | Improving symptoms in medical group |
| 2. FEV1 and peak flow | Improving FEV1 | ||||
| Medical group, CRSsNP/CRSwNP | 1. Medication use | Lowering medication needs | |||
| 2. Hospitalization | Lowering hospitalization rate | ||||
| Vashishta et al55 | 2a | Systematic review | 1. CRS patients | 1. Overall asthma control | FESS in patients with concomitant bronchial asthma improves clinical asthma outcome measures, but not lung function testing |
| 2. Asthma attacks | |||||
| 2. At least one asthma outcome reported | 1. Number of hospitalizations | ||||
| 2. Use of oral corticosteroids | |||||
| Dejima et al66 | 2a | Prospective controlled trial | 1. CRS with asthma | 1. Lower airway symptoms | Improving symptoms |
| 2. CRS without asthma | 2. Sinonasal symptoms | Lowering medication needs | |||
| Improving FEV1 | |||||
| Ikeda et al67 | 2a | Prospective controlled | 1. CRSwNP | 1. Sinonasal and pulmonary symptoms | Improving FEV1 |
| 2. CRSsNP | 2. Medication use | Any changes in medication needs | |||
| Ehnhage et al68 | 2b | Cohort study | Patients with CRSwNP and asthma, after FESS | 1. Dyspnea/cough scores | 1. Improvement in asthma symptoms score |
| 2. Mean daily peak expiratory flow rate | |||||
| 3. Spirometry | 2. Improvement in daily peak expiratory flow | ||||
| 4. Butanol test | |||||
| 5. Olfaction score | |||||
| 6. Peak nasal inspiratory flow | 3. Improvement in all nasal parameters | ||||
| 7. Polyps score | |||||
| Uri et al62 | 2b | Prospective not controlled | CRSwNP and asthma | 1. Subjective asthma and sinonasal questionnaire | Improving symptoms |
| 2. Spirometry | Lowering medication needs | ||||
| 3. Medication use | No changes in FEV1 | ||||
| Lamblin et al69 | 2b | Prospective not controlled | 1. Nasal symptoms | Any changes in symptoms | |
| CRSwNP and asthma | 2. Lower airway clinical and biochemical parameters | Any changes in asthma severity | |||
| Any changes in methacholine test | |||||
| Senior et al51 | 2b | Prospective not controlled | 1. Symptoms score | Improving symptoms | |
| CRS with asthma | 2. Asthma exacerbations | Lowering asthma relapses | |||
| 3. Medication use | Lowering medication needs | ||||
| Manning et al52 | 2b | Prospective not controlled | Symptoms score | Lowering medication need | |
| Nishioka et al70 | 2b | Prospective not controlled | 1. Symptoms score | Improving symptoms | |
| Adults with CRS after FESS | 2. Medication use | Lowering medication needs | |||
| 3. Number of emergency visits | Lowering emergency visits | ||||
| Zhang et al71 | 3 | Retrospective | Adults with CRS after FESS | QoL (SNOT-22) | Patients with both asthma and CRSwNP or asthma alone experience a larger QoL benefit after FESS (1 and 3 months) compared to CRS patients without asthma or polyps |
| Batra et al53 | 3 | Retrospective | CRSwNP and asthma | 1. Symptoms score | Improving symptoms |
| 2. Medication use | Lowering medication needs | ||||
| 3. Number of emergency visits | Lowering number of emergency visits | ||||
| 4. FEV1 change | Any changes in FEV1 | ||||
| Palmer et al50 | 3 | Retrospective | Adults with CRS after FESS | 1. Lung function | Lowering medication needs |
| 2. Medication use | |||||
| Dunlop et al72 | 3 | Retrospective | 1. CRSwNP | 1. Symptoms score | Improving symptoms |
| 2. Medication use | Lowering medication needs | ||||
| 3. Number of emergency visits | Lowering hospitalization rates | ||||
| 2. CRSsNP | 4. FEV1 change | Improving FEV1 | |||
| Any changes in CRSwNP group | |||||
| Goldstein et al73 | 3 | Retrospective | Adults with CRS after FESS | 1. Any changes in symptoms | No improvement after ESS |
| 2. Medication needs | |||||
| 3. Hospitalization rate | |||||
| 4. Emergency visits | |||||
| 5. FEV1 change |
Abbreviations: LOE, level of evidence; AIA, asthma intolerant to nonsteroidal antinflammatory drugs; ATA, asthma tolerant to nonsteroidal anti-inflammatory drugs; AD, aspirin desensitization; CRSsNP, chronic rhinosinusitis without nasal polyps; CRSwNP, chronic rhinosinusitis with nasal polyps; FESS, functional endoscopic sinus surgery; SNOT, sinonasal outcome test; QoL, quality of life; FPND; fluticasone propionate nasal drops; FEV1, forced expiratory volume in 1 second.