The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis
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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.
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.
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.
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.
KeywordsAsthma Chronic rhinosinusitis Endoscopic sinus surgery Pulmonary function tests Systematic review Meta-analysis
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).
Compliance with ethical standards
Conflict of interest
No conflicts of interest to declare.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 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
- 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 CrossRefGoogle 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
- 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)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 CrossRefGoogle 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 CrossRefGoogle 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 CrossRefGoogle Scholar