1
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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2
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Chen I, Gete M, Sichel JY, Forer B. Posisep Versus
PureRegen
Gel for Post
ESS
Nasal Packing – A Randomized Blinded Prospective Study. Laryngoscope 2022. [DOI: 10.1002/lary.30468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Itay Chen
- Department of Otolaryngology‐Head and Neck Surgery, Shaare Zedek Medical Center The Hebrew University Jerusalem Israel
| | - Maru Gete
- Department of Otolaryngology‐Head and Neck Surgery, Shaare Zedek Medical Center The Hebrew University Jerusalem Israel
| | - Jean Yves Sichel
- Department of Otolaryngology‐Head and Neck Surgery, Shaare Zedek Medical Center The Hebrew University Jerusalem Israel
| | - Boaz Forer
- Department of Otolaryngology‐Head and Neck Surgery, Shaare Zedek Medical Center The Hebrew University Jerusalem Israel
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3
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Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1434-1453.e9. [PMID: 35306180 DOI: 10.1016/j.jaip.2022.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Chronic rhinosinusitis (CRS) affects up to 12% of the general population and is traditionally divided into two main phenotypic subsets, based on the presence of nasal polyps (CRSwNP) or their absence. It is well-established that many patients with CRSwNP report poor quality of life (QoL), which is further compromised by comorbidities (eg, asthma, bronchiectasis, aspirin-exacerbated respiratory disease). Chronic rhinosinusitis CRS with nasal polyps is managed with a combination of medical therapy and surgical interventions, and biologics are emerging as a promising new treatment option for patients with inadequate response to the standard of care. A range of patient-reported outcome measures have been used to assess QoL for patients with CRSwNP in clinical trials, including disease-specific questionnaires (eg, Sino-Nasal Outcome Test-22) and generic ones (eg, Short Form-36). Significantly impaired QoL has been identified as a criterion for the indication to use biologics in patients with CRSwNP. This review summarizes clinical evidence (2010-2021) on QoL outcomes with currently available treatments for CRSwNP and assesses the improvement in QoL after biologic treatments, especially for patients with comorbidities reported in interventional studies (randomized controlled trials and real-world experience).
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Affiliation(s)
- Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy, Hospital Clinic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universidad de Barcelona, Centro Investigación Biomédica En Red Enfermedades Respiratorias, Barcelona, Spain.
| | - Antoine Azar
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Kathleen M Buchheit
- AERD Center, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Claire Hopkins
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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4
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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5
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Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB, Lee SE, Levy JM, Lin SY, Lio PA, Peters AT, Platt MP, White AA. Targeted Molecular Therapies in Allergy and Rhinology. Otolaryngol Head Neck Surg 2020; 164:S1-S21. [PMID: 33138725 DOI: 10.1177/0194599820965233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). This paper summarizes the diagnosis and management of these conditions and critically reviews the clinical trial data that has led to regulatory approval of biologic agents for these conditions.
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Affiliation(s)
| | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Stella E Lee
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sandra Y Lin
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Peter A Lio
- Northwestern Medicine, Chicago, Illinois, USA
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6
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Plaza V, Del Cuvillo A, Soto-Retes L, Gras JR, Cisneros C, Sánchez-Cuellar S, Gómez-Bastero A, Martínez-Moragón E, Sabadell C, Quirce S, Álvarez F, Rosado A, Lluch I, Soto G. Functional Endoscopic Sinus Surgery for Nasal Polyposis in Asthma Patients: Impact on Bronchial Inflammation. Arch Bronconeumol 2020; 56:403-405. [PMID: 35373752 DOI: 10.1016/j.arbr.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/30/2019] [Indexed: 06/14/2023]
Affiliation(s)
- Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain.
| | - Alfonso Del Cuvillo
- Unidad de Rinología y Asma, UGC ORL, Hospital Universitario de Jerez, Cádiz, Spain
| | - Lorena Soto-Retes
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Joan Ramón Gras
- Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Carolina Cisneros
- Servicio de Neumología, Hospital de la Princesa, Instituto de Investigación La Princesa (IP), Madrid, Spain
| | | | | | | | | | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, and CIBER or Respiratory Diseases CIBERES, Madrid, Spain
| | | | - Ana Rosado
- Unidad de Alergia, Hospital U, Fundación Alcorcón, Madrid, Spain
| | - Inmaculada Lluch
- Servicio de Neumología, Hospital de la Ribera, Alcira, Valencia, Spain
| | - Gregorio Soto
- Unidad de Gestión Clínica de Neumología y Alergia, Hospital Universitario de Jerez, Cádiz, Spain
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7
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Plaza V, Del Cuvillo A, Soto-Retes L, Gras JR, Cisneros C, Sánchez-Cuellar S, Gómez-Bastero A, Martínez-Moragón E, Sabadell C, Quirce S, Álvarez F, Rosado A, Lluch I, Soto G. Functional Endoscopic Sinus Surgery for Nasal Polyposis in Asthma Patients: Impact on Bronchial Inflammation. Arch Bronconeumol 2020. [PMID: 32037104 DOI: 10.1016/j.arbres.2019.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain.
| | - Alfonso Del Cuvillo
- Unidad de Rinología y Asma, UGC ORL, Hospital Universitario de Jerez, Cádiz, Spain
| | - Lorena Soto-Retes
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Joan Ramón Gras
- Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Carolina Cisneros
- Servicio de Neumología, Hospital de la Princesa, Instituto de Investigación La Princesa (IP), Madrid, Spain
| | | | | | | | | | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, and CIBER or Respiratory Diseases CIBERES, Madrid, Spain
| | | | - Ana Rosado
- Unidad de Alergia, Hospital U, Fundación Alcorcón, Madrid, Spain
| | - Inmaculada Lluch
- Servicio de Neumología, Hospital de la Ribera, Alcira, Valencia, Spain
| | - Gregorio Soto
- Unidad de Gestión Clínica de Neumología y Alergia, Hospital Universitario de Jerez, Cádiz, Spain
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8
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Cao Y, Hong H, Sun Y, Lai Y, Xu R, Shi J, Chen F. The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:1405-1411. [PMID: 30799521 DOI: 10.1007/s00405-019-05337-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Yujie Cao
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Haiyu Hong
- Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yueqi Sun
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yinyan Lai
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Rui Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
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9
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The Impact of Endonasal Endoscopic Sinus Surgery on Patients with Chronic Pulmonary Diseases. SINUSITIS 2017. [DOI: 10.3390/sinusitis2020004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Whitcroft KL, Andrews PJ, Randhawa PS. Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery. Clin Otolaryngol 2017; 42:1187-1192. [PMID: 28247540 DOI: 10.1111/coa.12859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). DESIGN Prospective cohort. SETTING Royal National Throat Nose and Ear Hospital. PARTICIPANTS Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). MAIN OUTCOME MEASURES PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. RESULTS In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). CONCLUSIONS Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire.
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Affiliation(s)
- K L Whitcroft
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK.,UCL Ear Institute, London, UK
| | - P J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK.,UCL Ear Institute, London, UK
| | - P S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
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11
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Schlosser RJ, Smith TL, Mace J, Soler ZM. Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis. Allergy 2017; 72:483-491. [PMID: 27638398 DOI: 10.1111/all.13048] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 12/24/2022]
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 pre-operative 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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Affiliation(s)
- R. J. Schlosser
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
| | - T. L. Smith
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - J. Mace
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health Sciences University; Portland OR USA
| | - Z. M. Soler
- Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston SC USA
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12
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Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy 2016; 9:45-53. [PMID: 27042129 PMCID: PMC4798207 DOI: 10.2147/jaa.s86251] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have coexisting asthma under the concept of “United Airway Disease”, being the combination of both diseases, which is one of the most challenging phenotypes to treat. Although clinicians have recognized this difficult-to-treat phenotype for many years, it remained poorly characterized. There is increasing epidemiological evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and the combined management is still lacking. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis, while asthmatic patients have a greater prevalence of CRSwNP than patients without asthma. The effect of CRSwNP treatment, whether medical or surgical, in asthma is today less controversial after some studies have shown improvement of asthma after medical and/or surgical treatment of CRSwNP. However, direct comparisons between surgical and medical treatments are limited. Further randomized clinical trials are, however, still needed to better understand the management when both asthma and CRSwNP occur together. This review aims at summarizing the prevalence, impact, and management challenges regarding both asthma and CRSwNP.
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Affiliation(s)
- Cristobal Langdon
- Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centre for Biomedical Research in Respiratory Diseases (CIBERES), Barcelona, Catalonia, Spain
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
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- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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14
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Rix I, Håkansson K, Larsen CG, Frendø M, von Buchwald C. Management of chronic rhinosinusitis with nasal polyps and coexisting asthma: A systematic review. Am J Rhinol Allergy 2016; 29:193-201. [PMID: 25975250 DOI: 10.2500/ajra.2015.29.4178] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and asthma are strongly associated, and patients suffering from both diseases are often difficult to treat. However, no guidelines about the management of patients with CRS and coexisting asthma exist. OBJECTIVE The purpose of this systematic review was to evaluate the management of CRSwNP and coexisting asthma. METHODS We systematically searched electronic databases and included clinical trials in which the clinical outcomes after medical or surgical treatment of patients with CRSwNP and asthma were assessed. The strength of the evidence for each outcome was graded on the basis of study quality and consistency in findings. RESULTS We included seven trials in which the effect of montelukast, omalizumab, erythromycin, and functional endoscopic sinus surgery (FESS) were studied in 317 adults with CRSwNP and asthma. All the interventions improved the majority of subjective and objective nasal outcomes significantly. However, few studies found significant effects on pulmonary function tests. The strength of the evidence was low overall. CONCLUSION Both FESS and medical interventions with systemic anti-inflammatory drugs improved nasal outcomes, although their efficacy in relation to the lower airways remains unclear. A low number of studies met inclusion criteria for this systematic review, which emphasizes the need for high-quality trials to explore the treatment of patients with CRSwNP and coexisting asthma.
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Affiliation(s)
- Iben Rix
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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15
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Lee DY, Lee WH, Wee JH, Kim JW. Prognosis of postviral olfactory loss: follow-up study for longer than one year. Am J Rhinol Allergy 2015; 28:419-22. [PMID: 25198029 DOI: 10.2500/ajra.2014.28.4102] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There have been very few studies on the prognosis of postviral olfactory dysfunction. The aim of the study was to evaluate its long-term prognosis and factors influencing the prognosis. METHODS This study included patients who were diagnosed with postviral olfactory dysfunction at least one year ago in a Smell and Taste Clinic and whose telephone interviews were available. Their medical records were reviewed, and they were asked to score their subjective olfactory function on a 100-point scale by telephone interview. RESULTS A total of 63 patients and 20 normal controls without nasal pathology were included. The mean age of the patients was 49.5 years, and 19 males and 44 females were included. The mean length of follow-up was 33.4 months. Olfactory dysfunction was subjectively improved in 85.7% of the patients. The recovery rate to subjective normosmia was 31.7%. The mean symptom scores for smell significantly increased in comparison with baseline from 25.6 to 69.0. Among the 25 patients (37.7%) who underwent follow-up butanol threshold test (BTT), the score improved from 4.6 to 7.3. Olfactory improvement was more frequently reported by females (p = .003) and in patients with follow-up duration for longer than 2 years (p = .043). CONCLUSIONS Follow-up of postviral olfactory loss revealed that over 80% of the patients reported subjective recovery after one year. The more favorable prognosis was associated with longer follow-up duration and female gender.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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16
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Licari A, Caimmi S, Bosa L, Marseglia A, Marseglia GL, Caimmi D. Rhinosinusitis and asthma: a very long engagement. Int J Immunopathol Pharmacol 2015; 27:499-508. [PMID: 25572729 DOI: 10.1177/039463201402700405] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Upper and lower airways may be considered as a unique entity, interested by coexisting inflammatory processes that share common etiopathogenic mechanisms. Previous studies have strongly demonstrated a relationship between rhinosinusitis and asthma. This has led to the introduction of the concept of United Airways, which has also been included in the WHO document Allergic Rhinitis and its Impact on Asthma (ARIA); this concept has important consequences also on the treatment of these disorders. To better summarize the evident connection between upper and lower airway disease we decided to describe it as a multilayered construction, each level pointing out more deeply the relationship between these entities.
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Affiliation(s)
- A Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - S Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - L Bosa
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - A Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - G L Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - D Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
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Yu S, Wee J, Kim JW, Yoon S. Methodology for Big Data Analysis Using Data from National Health Insurance Service: Preliminary Methodologic Study and Review about the Relationship between Sinus Surgery and Asthma. JOURNAL OF RHINOLOGY 2015. [DOI: 10.18787/jr.2015.22.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seunghak Yu
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Jaewoon Wee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungroh Yoon
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
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18
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Nguyen DT, Guillemin F, Arous F, Jankowski R. Assessment of quality-of-life outcomes after surgery for nasal polyposis with the DyNaChron questionnaire. Eur Arch Otorhinolaryngol 2014; 272:367-75. [PMID: 24899410 DOI: 10.1007/s00405-014-3109-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/19/2014] [Indexed: 01/11/2023]
Abstract
This prospective study assesses outcomes at 6 weeks and 7 months after radical ethmoid surgery in 65 patients with nasal polyposis using a new and detailed instrument, the DyNaChron questionnaire, which was filled in the day prior to surgery and at 6 weeks and 7 months after surgery at follow-up visits. Before surgery, the leading bothersome symptoms were olfactory disturbances (7.74 ± 2.81) and nasal obstruction (6.66 ± 2.28). After surgery (6th week and 7th month), there was a clear improvement of all symptoms including nasal obstruction, olfactory disturbances, anterior rhinorrhea, postnasal discharge, facial pain/headache and cough in comparison to baseline (p < 0.0001). Nasal obstruction was the most improved symptom (effect size of 2.24). At 7th post-operative month, the sense of smell continued to improve slightly. By contrast, the postnasal discharge score that was significantly improved at 6th post-operative week tended to worsen at 7 months (p = 0.0045). Before surgery, strong psychosocial impacts were observed in association with nasal obstruction and anterior rhinorrhea. The physical impacts of each symptom were proportionally correlated to the symptom score before and after surgery. The quality of life (QOL) related to each symptom was clearly better at 6 weeks and remained steady at 7 months after surgery. In conclusion, olfactory disorders and postnasal rhinorrhea were the main remaining symptoms after sinus surgery despite a global improvement of symptoms and quality of life. The earlier time point to stabilize QOL outcomes of endoscopic sinus surgery could be suggested at 6 weeks after surgery.
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Affiliation(s)
- Duc Trung Nguyen
- Departments of ENT, Head and Neck Surgery, Nancy University Hospital - Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, Av. du Maréchal de Lattre de Tassigny, 54000, Nancy, France,
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19
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Valdes CJ, Bogado M, Rammal A, Samaha M, Tewfik MA. Topical cocaine vs adrenaline in endoscopic sinus surgery: a blinded randomized controlled study. Int Forum Allergy Rhinol 2014; 4:646-50. [PMID: 24678064 DOI: 10.1002/alr.21325] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 01/20/2014] [Accepted: 02/14/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adequate surgical field visualization is among the most important factors in preventing complications in functional endoscopic sinus surgery (FESS). The aim of this study was to assess the effect of topical cocaine vs adrenaline on surgical field visualization and intraoperative bleeding during FESS. METHODS A randomized controlled trial was conducted. A total of 37 patients that underwent FESS for chronic rhinosinusitis were randomized to the side of the nose that received adrenaline or cocaine-soaked patties, and the side that was operated first. The surgeon evaluating the bleeding was blinded to the vasoconstrictor allocation. At the commencement of surgery and at regular 15-minute intervals, the operating surgeon evaluated the extent of bleeding in the operative field according to a validated scale. At each assessment, mean arterial pressure (MAP), heart rate, and end tidal CO2 were also recorded. At the end of each side, total blood loss was measured. RESULTS There was no difference in the mean surgical field scores between the adrenaline and cocaine sides (2.04 ± 0.75 vs 2.17 ± 0.7, p = 0.24), nor the total blood loss (p = 0.43). On the cocaine side, there was a correlation between surgical field grade and duration of surgery (p < 0.05) as well as blood loss (p < 0.05) and MAP (p < 0.05). CONCLUSION There is no difference in the quality of the surgical field achieved through the use of topical cocaine or adrenaline during FESS. Either of these agents can be effectively used for topical decongestion at the onset of surgery.
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Affiliation(s)
- Constanza J Valdes
- Department of Otolaryngology-Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile; Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
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Chang CC, Incaudo GA, Gershwin ME. Sinusitis, Rhinitis, Asthma, and the Single Airway Hypothesis. DISEASES OF THE SINUSES 2014. [PMCID: PMC7121820 DOI: 10.1007/978-1-4939-0265-1_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The one airway, one disease hypothesis proposes that the upper and lower airways share the same physiology and histomorphology. Epidemiological clinical studies support a link between rhinosinusitis and asthma. The relationship can occur in both directions, with nasal allergen challenge leading to inflammatory changes in the lower airway and bronchoprovocation studies of the lower airway leading to inflammatory changes in the upper airway. In addition, both similarities and differences exist in the pathogenesis of nasal polyps and asthma. The mechanism for the connection between the upper and lower airways is a matter of great debate. It has been proposed that inflammatory changes in the lower airway may lead to systemic inflammatory effects that play a role in increased bronchial hyperresponsiveness. Similarly, lower airway inflammatory changes may affect nasal airway patency via systemic effects. Moreover, nasopharyngeal-bronchial reflexes may play a non-immunologic role in the interaction between the lower and upper airways. An example of the connection between the upper and lower airways is found in aspirin-exacerbated respiratory disease whereby leukotrienes play a role in the pathology of chronic rhinosinusitis with polyps and asthma. It is also been observed that the treatment of asthma is hindered by untreated rhinosinusitis.
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Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
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Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2013; 3:788-94. [PMID: 23818462 DOI: 10.1002/alr.21182] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/24/2013] [Accepted: 04/30/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients suffering from both chronic rhinosinusitis (CRS) and asthma demonstrate improved asthma outcomes when upper airway inflammation is controlled with medications. It is unclear if similar benefits exist when the upper airway is treated surgically. This study presents a systematic review and meta-analysis to assess the effects of endoscopic sinus surgery (ESS) on asthma outcomes. METHODS Ovid MEDLINE and the Cochrane databases were searched to identify studies examining asthma outcomes in patients with CRS following ESS. Included studies involved a cohort of at least 5 patients and reported at least 1 postoperative asthma outcome. RESULTS Twenty-two studies involving a total of 891 patients were identified. Mean follow-up across all studies was 26.4 months. Patients reported improved overall asthma control in 76.1% (95% confidence interval [CI], 71.9% to 80.3%) of cases. The frequency of asthma attacks decreased in 84.8% (95% CI, 76.6% to 93.0%) of patients and the number of hospitalizations decreased in 64.4% (95% CI, 53.3% to 75.6%). Decreased use of oral corticosteroids was seen in 72.8% (95% CI, 67.5% to 78.1%) of patients; inhaled corticosteroid use decreased in 28.5% (95% CI, 22.6% to 34.5%) and bronchodilator use decreased in 36.3% (95% CI, 28.9% to 43.7%) of patients. Mean improvement in predicted forced expiratory volume at 1 second (FEV1 ) was 1.62%, but was not statistically significant (p = 0.877). CONCLUSION ESS in patients with concomitant bronchial asthma improves clinical asthma outcome measures, but not lung function testing. Difficulty conducting controlled clinical trials of ESS limits the strength of conclusions which can be reached.
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Affiliation(s)
- Rishi Vashishta
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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22
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Nasal polyposis: an inflammatory condition requiring effective anti-inflammatory treatment. Curr Opin Otolaryngol Head Neck Surg 2013; 21:23-30. [PMID: 23172039 DOI: 10.1097/moo.0b013e32835bc3f9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Recent literature in chronic rhinosinusitis with nasal polyps (CRSwNP) has focussed on inflammatory mechanisms underlying the disease. Endotyping the histopathological features of the disease, rather than simple clinical phenotypes, reflects a change in our understanding of the disease and approach to management. This is paralleled by renewed evidence for the need for wide postsurgical access and topical anti-inflammatory therapy. RECENT FINDINGS Recent research into patterns of dysfunction in innate immunity suggests a crucial role of respiratory epithelium in mediating the inflammatory response. Elevated interleukins, IL-25 and IL-33, from sinus mucosa in CRSwNP and their interaction via innate lymphoid cells may represent the link between the host-environment interface and T-helper 2 dominated inflammation that characterizes CRSwNP. While thorough immunological profiling of CRSwNP is not routinely available, classification of CRS as eosinophilic (ECRS) or noneosinophilic is practical and correlates with disease severity and prognosis. The practice and utility of endoscopic sinus surgery to create a single neosinus for topical corticosteroid delivery is a logical conclusion founded on the inflammatory basis of CRSwNP/ECRS. SUMMARY There is mounting evidence for CRSwNP as a predominantly inflammatory disease. Even simple histopathological classification on the basis of degrees of tissue eosinophilia reflects the underlying pathogenic mechanisms with diagnostic and prognostic implications. Optimal treatment involves topical anti-inflammatory therapy delivered locally via a wide, postsurgical corridor.
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