Sinusitis and Asthma: How do they Interrelate in Sinus Surgery?

Abstract

Sinusitis has been suspected to be etiopathogenically linked to bronchial asthma. Asthma, on the other hand, has been reported to affect negatively the outcome of sinus surgery. The purpose of this study is to elucidate how sinusitis and asthma clinically interrelate, in a group of asthmatic subjects undergoing surgical interventions on the sinuses. A total of 43 asthmatic patients, selected for functional endoscopic sinus surgery, preoperatively had their sinus disease staged and their lung function tested, and were evaluated for allergy and aspirin sensitivity. One year after surgery the surgical results were analyzed, lung function was re-assessed, and patients' clinical status addressed through a questionnaire; and 93 nonasthmatic patients, whose functional endoscopic sinus surgery was contemporaneous, were used as a control group for the surgical results. Asthma was a critical factor negatively affecting the outcome of sinus surgery. On the other hand, sinus disease extension did not correlate with asthma severity at any stage. Sinus surgery, despite being capable of improving asthma, ultimately failed to produce significant change in lung function scores. Furthermore, consistent good surgical results on the nose did not come across as a critical issue for postoperative asthma improvement. We concluded that, if the surgical intervention on the sinuses was found to be able clinically to benefit asthma evolution, other evidence does not seem to support a causative relationship between sinusitis and asthma. Instead, since asthma was shown to affect sinus disease severity significantly, their association apparently reflects a systemic inflammatory process of the respiratory mucosa.

A Clinical Study of Endoscopic Sinus Surgery for Sinusitis in Patients with Bronchial Asthma

“…Schaitkin et al [16] reported that if asthma was present, the improvement in subjective symptoms was less. Dinis and Gomes [17] found that although there was no significant difference in symptomatic findings between patients with and without asthma, the outcome of ESS in the asthma group was poor by objective assessment, and they reported that asthma is a bad prognostic factor. Poor outcomes of ESS have also been reported in asthma-complicated sinusitis with aspirin sensitivity [18, 19].…”

Role of Interleukin-17A in the Eosinophil Accumulation and Mucosal Remodeling in Chronic Rhinosinusitis with Nasal Polyps Associated with Asthma

“…Mucosal infiltration with enriched eosinophils in CRS with nasal polyps may be the distinctive feature of tissue eosinophilia, which is more refractory to surgical cure and is frequently associated with bronchial asthma [13, 14]. Several studies have reported the aspects of the clinical relationship between CRS and asthma [15,16,17].…”

Reduction in Superoxide Dismutase Expression in the Epithelial Mucosa of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

“…CRS with nasal polyps associated with mucosal infiltration of eosinophils may be regarded as eosinophilic CRS due to the distinctive feature of tissue eosinophilia [3], which is more refractory to surgical treatment and is frequently associated with bronchial asthma. The histopathological features of asthma, including tissue eosinophils, epithelial damage and basement membrane thickening of the lower airways, are also observed in sinonasal specimens with CRS [4].…”