title: Quality of life improvement from sinus surgery in chronic rhinosinusitis patients with asthma and nasal polyps.
abstract: BACKGROUND
  It is unclear whether chronic rhinosinusitis (CRS) patients with both nasal polyps and asthma have different quality of life (QOL) improvement after functional endoscopic sinus surgery (FESS). We aimed to determine whether CRS patients with asthma and nasal polyps had a greater QOL improvement after FESS compared to patients without asthma or polyps.
  
  
  METHODS
  This retrospective analysis included adult CRS patients who underwent FESS between 2007 and 2011. QOL was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, clinical factors, SNOT-22 scores before FESS, and 1 month, 3 months, and 6 months post-FESS. Groups tested were asthma alone, polyps alone, asthma and polyps, and no asthma or polyps. Linear mixed-effects regression model was performed to calculate β-coefficients, which represent the adjusted mean QOL differences.
  
  
  RESULTS
  Among the 376 patients included, 40.16% had both asthma and polyps (n = 151), 14.36% had asthma alone (n = 54), 19.45% had polyps alone (n = 75), and 25.53% had no asthma or polyps (n = 96). After adjusting for all factors, there were significantly more QOL improvements in patients with both asthma and nasal polyps from baseline to 1-month (β-coefficient = -10.05; 95% CI, -15.86 to -4.23; p = 0.001) and 3-month follow-up (β-coefficient = -8.27; 95% CI, -14.98 to -1.56; p = 0.016), and patients with asthma alone from baseline to 6-month follow-up (β-coefficient = -8.78; 95% CI, -17.45 to -0.11; p = 0.047), when compared to patients without asthma or nasal polyps.
  
  
  CONCLUSIONS
  CRS patients with both asthma and nasal polyps or asthma alone experience a larger QOL benefit from FESS immediately after FESS compared to CRS patients without asthma or polyps.
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A.
authors.forename: Zi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
authors.forename: Laurel J
authors.initials: LJ
authors.lastname: Doghramji
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
mesh_terms: D001249:Asthma / Q000150:complications* / Q000523:psychology; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications* / Q000523:psychology; D059747:Nasal Surgical Procedures / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000523:psychology / Q000601:surgery*
keywords: asthma; chronic rhinosinusitis; functional endoscopic sinus surgery; nasal polyps; quality of life