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

Abstract

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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