International forum of allergy & rhinology · 2025
Asthma Outcomes Following Early Versus Delayed Sinus Surgery in Chronic Rhinosinusitis With Nasal Polyps.
СтатьяНазвание и аннотация: Перевод в очереди
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Oliver Jamie R, Crafton Christopher L, Attwood Easton W, Farrokhian Nathan, Rangarajan Sanjeet, Villwock Jennifer A
Аннотация
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) often coexists with asthma. Endoscopic sinus surgery (ESS) improves asthma morbidity, but the impact of early surgery (< 6 months from diagnosis) versus later surgery (1-3 years) is unclear. We examined whether early ESS is associated with improved asthma outcomes compared with delayed surgery.
METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, including adults with CRSwNP who underwent ESS. Patients were grouped as early surgery (≤ 6 months after diagnosis) or late surgery (1-3 years). Outcomes over 5 years included asthma diagnoses by severity, exacerbations, and medication use (long-acting β2-agonists [LABA], corticosteroids, biologics). Propensity score matching was performed 1:1 (N = 3683 per group) based on demographics, baseline asthma severity, and asthma medication usage.
RESULTS: After matching, groups were well balanced. Early ESS was associated with lower risk of moderate (11.5% vs. 13.5%; odds ratio [OR] = 0.84; p = 0.012) and severe persistent asthma (6.5% vs. 8.4%; OR = 0.76; p = 0.003). Rates of mild intermittent or persistent asthma and overall new asthma diagnoses did not differ. Early surgery patients had fewer associated asthma exacerbations (6.4% vs. 8.1%; OR = 0.78; p = 0.005) and were less likely to require LABAs (23.7% vs. 29.4%; OR = 0.75; p < 0.0001), steroids (63.7% vs. 67.4%; OR = 0.85; p = 0.0009), and biologics (7.7% vs. 10.1%; OR = 0.74; p = 0.0004).
CONCLUSION: Early ESS for CRSwNP is associated with reduced progression to moderate/severe asthma, fewer exacerbations, and lower reliance on oral steroids, LABAs, and biologics. These findings suggest early surgery may alter asthma trajectory and reduce treatment burden in CRSwNP patients.
METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, including adults with CRSwNP who underwent ESS. Patients were grouped as early surgery (≤ 6 months after diagnosis) or late surgery (1-3 years). Outcomes over 5 years included asthma diagnoses by severity, exacerbations, and medication use (long-acting β2-agonists [LABA], corticosteroids, biologics). Propensity score matching was performed 1:1 (N = 3683 per group) based on demographics, baseline asthma severity, and asthma medication usage.
RESULTS: After matching, groups were well balanced. Early ESS was associated with lower risk of moderate (11.5% vs. 13.5%; odds ratio [OR] = 0.84; p = 0.012) and severe persistent asthma (6.5% vs. 8.4%; OR = 0.76; p = 0.003). Rates of mild intermittent or persistent asthma and overall new asthma diagnoses did not differ. Early surgery patients had fewer associated asthma exacerbations (6.4% vs. 8.1%; OR = 0.78; p = 0.005) and were less likely to require LABAs (23.7% vs. 29.4%; OR = 0.75; p < 0.0001), steroids (63.7% vs. 67.4%; OR = 0.85; p = 0.0009), and biologics (7.7% vs. 10.1%; OR = 0.74; p = 0.0004).
CONCLUSION: Early ESS for CRSwNP is associated with reduced progression to moderate/severe asthma, fewer exacerbations, and lower reliance on oral steroids, LABAs, and biologics. These findings suggest early surgery may alter asthma trajectory and reduce treatment burden in CRSwNP patients.