Skip to main content
SpringerLink
Log in

The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Evidences showed improvements in clinical asthma outcomes following endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) patients with asthma. However, pulmonary function benefits have remained controversial up to date. The goal of this study was to conduct a systematic review and meta-analysis to investigate the effects of ESS on pulmonary function tests in CRS patients with asthma.

Methods

Pubmed, Embase and Cochrane Library were searched up to March 2018 to obtain relevant studies. The researches that evaluated the effects of ESS on pulmonary function in CRS patients with asthma and had at least one parameter of pulmonary function tests before and after surgery were included in the study.

Results

A total of 13 studies containing 421 patients satisfied the eligibility after judgment by 2 reviewers. These included three RCTs and ten case series. The heterogeneity in parameters of spirometry and difference in data presented forms across studies along with the lack of standard deviation of some data make it difficult to synthesize results. If data were unavailable for meta-analyses, descriptive statistics were used to report study outcomes. After qualitative and quantitative analysis, the weighted mean change after ESS in forced expiratory flow between 25% and 75% of vital capacity (FEF25–75%) was 0.21 L/s (95% CI 0.12–0.30); eight of ten studies supported that forced expiratory volume at 1 s (FEV1) improved after ESS; five of six studies supported that peak expiratory flow (PEF) improved after ESS. However, strength of evidence is generally low to insufficient.

Conclusion

A generally low-quality evidence supports the association between ESS and improvements in FEF25–75%, FEV1 and PEF. A few studies met inclusion criteria for meta-analysis, which indicates the need for more high-quality studies to determine the effect of ESS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Beule A (2015) Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden. GMS current topics in otorhinolaryngology, head and neck surgery 14:Doc11. https://doi.org/10.3205/cto000126

  2. Shi JB, Fu QL, Zhang H, Cheng L, Wang YJ, Zhu DD, Lv W, Liu SX, Li PZ, Ou CQ, Xu G (2015) Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy 70(5):533–539. https://doi.org/10.1111/all.12577

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. National Asthma E, Prevention P (2007) Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol 120(5 Suppl):S94–S138. https://doi.org/10.1016/j.jaci.2007.09.043

    Article  Google Scholar 

  4. Hamid Q, Song Y, Kotsimbos TC, Minshall E, Bai TR, Hegele RG, Hogg JC (1997) Inflammation of small airways in asthma. J Allergy Clin Immunol 100(1):44–51

    Article  CAS  PubMed  Google Scholar 

  5. Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, Gjomarkaj M, Forsberg B, Gunnbjornsdottir M, Minov J, Brozek G, Dahlen SE, Toskala E, Kowalski ML, Olze H, Howarth P, Kramer U, Baelum J, Loureiro C, Kasper L, Bousquet PJ, Bousquet J, Bachert C, Fokkens W, Burney P (2012) Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy 67(1):91–98. https://doi.org/10.1111/j.1398-9995.2011.02709.x

    Article  CAS  PubMed  Google Scholar 

  6. Virant FS (2001) Sinusitis and asthma: associated airway diseases. Curr Allergy Asthma Rep 1(3):277–281

    Article  CAS  PubMed  Google Scholar 

  7. Dunlop G, Scadding GK, Lund VJ (1999) The effect of endoscopic sinus surgery on asthma: management of patients with chronic rhinosinusitis, nasal polyposis, and asthma. Am J Rhinol 13(4):261–265

    Article  CAS  PubMed  Google Scholar 

  8. Goldstein MF, Grundfast SK, Dunsky EH, Dvorin DJ, Lesser R (1999) Effect of functional endoscopic sinus surgery on bronchial asthma outcomes. Arch Otolaryngol Head Neck Surg 125(3):314–319

    Article  CAS  PubMed  Google Scholar 

  9. Ikeda K, Tanno N, Tamura G, Suzuki H, Oshima T, Shimomura A, Nakabayashi S, Takasaka T (1999) Endoscopic sinus surgery improves pulmonary function in patients with asthma associated with chronic sinusitis. The annals of otology, rhinology, and laryngology 108 (4):355–359. https://doi.org/10.1177/000348949910800407

  10. Dhong HJ, Jung YS, Chung SK, Choi DC (2001) Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 124(1):99–104. https://doi.org/10.1067/mhn.2001.111596

    Article  CAS  Google Scholar 

  11. Batra PS, Kern RC, Tripathi A, Conley DB, Ditto AM, Haines IGK, Yarnold PR, Grammar L (2003) Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma. Laryngoscope 113(10):1703–1706. https://doi.org/10.1097/00005537-200310000-00008

    Article  PubMed  Google Scholar 

  12. Dejima K, Hama T, Miyazaki M, Yasuda S, Fukushima K, Oshima A, Yasuda M, Hisa Y (2005) A clinical study of endoscopic sinus surgery for sinusitis in patients with bronchial asthma. Int Arch Allergy Immunol 138(2):97–104. https://doi.org/10.1159/000088430

    Article  PubMed  Google Scholar 

  13. Ragab S, Scadding GK, Lund VJ, Saleh H (2006) Treatment of chronic rhinosinusitis and its effects on asthma. Eur Respir J 28(1):68–74. https://doi.org/10.1183/09031936.06.00043305

    Article  CAS  PubMed  Google Scholar 

  14. Gulati SP, Chaudhry D, Kalra V, Wadhera R, Garg A (2008) The role of functional endoscopic sinus surgery (FESS) in patients with asthma with chronic sinusitis. Indian J Otolaryngol Head Neck Surg 60(2):152–155. https://doi.org/10.1007/s12070-008-0037-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Nair S, Bhadauria RS, Sharma S (2010) Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg 62(3):285–288. https://doi.org/10.1007/s12070-010-0086-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Proimos E, Papadakis CE, Chimona TS, Kiagiadaki D, Ferekidis E, Yiotakis J (2010) The effect of functional endoscopic sinus surgery on patients with asthma and CRS with nasal polyps. Rhinology 48(3):331–338. https://doi.org/10.4193/Rhin09.123

    Article  CAS  PubMed  Google Scholar 

  17. Razmpa E, Saedi B, Safavi A (2010) The effect of functional endoscopic sinus surgery on pulmonary improvement of controlled asthmatic patients with chronic sinusitis. Iran J Allergy Asthma Immunol 9(4):231–236. (09.04/ijaai.231236)

    PubMed  Google Scholar 

  18. Ehnhage A, Olsson P, Kölbeck KG, Skedinger M, Stjärne P (2012) One year after endoscopic sinus surgery in polyposis: asthma, olfaction, and quality-of-life outcomes. Otolaryngol Head Neck Surg 146(5):834–841. https://doi.org/10.1177/0194599811435638

    Article  PubMed  Google Scholar 

  19. Chen FH, Zuo KJ, Guo YB, Li ZP, Xu G, Xu R, Shi JB (2014) Long-term results of endoscopic sinus surgery-oriented treatment for chronic rhinosinusitis with asthma. Laryngoscope 124(1):24–28. https://doi.org/10.1002/lary.24196

    Article  PubMed  Google Scholar 

  20. Dinakar C, Chipps BE, Section On A, Immunology SO, Pediatric P, Sleep M (2017) Clinical tools to assess asthma control in children. Pediatrics. https://doi.org/10.1542/peds.2016-3438

    Article  PubMed  Google Scholar 

  21. Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ (2013) A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 3(10):788–794. https://doi.org/10.1002/alr.21182

    Article  PubMed  Google Scholar 

  22. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. https://doi.org/10.1016/j.jclinepi.2009.06.006

    Article  Google Scholar 

  23. Manoharan A, Anderson WJ, Lipworth J, Ibrahim I, Lipworth BJ (2014) Small airway dysfunction is associated with poorer asthma control. Eur Respir J 44(5):1353–1355. https://doi.org/10.1183/09031936.00082314

    Article  PubMed  Google Scholar 

  24. van den Berge M, Ten Hacken NHT, Cohen J, Douma WR, Postma DS (2011) Small airway disease in asthma and COPD: clinical implications. Chest 139(2):412–423. https://doi.org/10.1378/chest.10-1210

    Article  PubMed  Google Scholar 

  25. Alfieri V, Aiello M, Pisi R, Tzani P, Mariani E, Marangio E, Olivieri D, Nicolini G, Chetta A (2014) Small airway dysfunction is associated to excessive bronchoconstriction in asthmatic patients. Respir Res 15:86. https://doi.org/10.1186/s12931-014-0086-1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bjermer L (2014) The role of small airway disease in asthma. Curr Opin Pulmon Med 20(1):23–30. https://doi.org/10.1097/MCP.0000000000000018

    Article  Google Scholar 

  27. Virchow JC (2009) [Asthma–a small airway disease: concepts and evidence]. Pneumologie 63(2):S96–S101. https://doi.org/10.1055/s-0029-1214715

    Article  PubMed  Google Scholar 

  28. Siroux V, Boudier A, Dolgopoloff M, Chanoine S, Bousquet J, Gormand F, Just J, Le Moual N, Nadif R, Pison C, Varraso R, Matran R, Pin I (2016) Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. J Allergy Clin Immunol 137(6):1709–1716 e1706. https://doi.org/10.1016/j.jaci.2015.10.029

    Article  PubMed  Google Scholar 

  29. Tepper RS, Wise RS, Covar R, Irvin CG, Kercsmar CM, Kraft M, Liu MC, O’Connor GT, Peters SP, Sorkness R, Togias A (2012) Asthma outcomes: pulmonary physiology. J Allergy Clin Immunol 129(3 Suppl):S65–S87. https://doi.org/10.1016/j.jaci.2011.12.986

    Article  PubMed  PubMed Central  Google Scholar 

  30. Goldberg S, Springer C, Avital A, Godfrey S, Bar-Yishay E (2001) Can peak expiratory flow measurements estimate small airway function in asthmatic children? Chest 120(2):482–488

    Article  CAS  PubMed  Google Scholar 

  31. Braunstahl GJ, Fokkens W (2003) Nasal involvement in allergic asthma. Allergy 58(12):1235–1243

    Article  PubMed  Google Scholar 

  32. Braunstahl GJ (2005) The unified immune system: respiratory tract-nasobronchial interaction mechanisms in allergic airway disease. J Allergy Clin Immunol 115(1):142–148. https://doi.org/10.1016/j.jaci.2004.10.041

    Article  CAS  PubMed  Google Scholar 

  33. Stirling RG, van Rensen EL, Barnes PJ, Chung KF (2001) Interleukin-5 induces CD34(+) eosinophil progenitor mobilization and eosinophil CCR3 expression in asthma. Am J Respir Crit Med 164(8 Pt 1):1403–1409. https://doi.org/10.1164/ajrccm.164.8.2010002

    Article  CAS  Google Scholar 

  34. Braunstahl GJ, Overbeek SE, Kleinjan A, Prins JB, Hoogsteden HC, Fokkens WJ (2001) Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways. J Allergy Clin Immunol 107(3):469–476. https://doi.org/10.1067/mai.2001.113046

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported by grant from the National Natural Science Fund of China (No. 81700886) and the Natural Science Foundation of Guangdong Province (No. 2016A030310166, 2014A030313106).

Author information

Authors and Affiliations

  1. Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China

    Yujie Cao, Yueqi Sun, Yinyan Lai, Rui Xu, Jianbo Shi & Fenghong Chen

  2. Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China

    Haiyu Hong

Authors
  1. Yujie Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haiyu Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yueqi Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yinyan Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rui Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jianbo Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fenghong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jianbo Shi or Fenghong Chen.

Ethics declarations

Conflict of interest

No conflicts of interest to declare.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cao, Y., Hong, H., Sun, Y. et al. The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 276, 1405–1411 (2019). https://doi.org/10.1007/s00405-019-05337-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05337-4

Keywords

Search

Navigation