title: Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma.
abstract: BACKGROUND
  The long-term impact of chronic rhinosinusitis (CRS) with or without allergic rhinitis (AR) on asthma is poorly documented. This study analyzed potential associations of ongoing CRS and AR on asthma.
  
  
  METHODS
  Using the MarketScan™ claims database, patients with CRS and endoscopic sinus surgery (ESS) in 2010 were identified. The date of first sinusitis was determined for all. Patients with asthma at time of first sinusitis diagnosis were excluded. The remaining patients were grouped based on duration of sinusitis, from first diagnosis to surgery-group 1: 1 to <2 years (n = 181); group 2: 2 to <3 years (n = 195); group 3: 3 to <4 years (n = 292); and group 4: 4 to <5 years (n = 536). Yearly incidence and prevalence of newly diagnosed asthmatics was analyzed for all groups. A secondary analysis evaluated the association between AR and asthma.
  
  
  RESULTS
  Preoperatively, yearly incidence of patients with new asthma diagnoses averaged 4.48% (95% confidence interval [CI], 3.93% to 5.11%) and was significantly greater for patients with AR (5.93%; 95% CI, 4.56% to 7.66%) vs non-AR (4.15%; 95% CI, 3.56% to 4.82%); p = 0.03. Postoperatively, yearly incidence of asthma was 0.42% (95% CI, 0.18% to 0.88%). No patient had asthma at time of first diagnosis; however, by time of surgery, 9.4%, 12.8%, 18.2%, and 22.40% of patients had been diagnosed with asthma, in groups 1 through 4, respectively.
  
  
  CONCLUSIONS
  AR was a significant risk factor for asthma in patients with CRS. Medically recalcitrant CRS was associated with high incidence rates of asthma, which declined post-operatively. Patients operated earlier in the disease continuum were therefore at decreased risk of developing asthma.
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.affiliation: Acclarent Inc, Menlo Park, CA.
authors.forename: Chantal E
authors.initials: CE
authors.lastname: Holy
authors.affiliation: ENT Department, Guy's Hospital, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000601:surgery; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000453:epidemiology* / Q000601:surgery; D012306:Risk; D012852:Sinusitis / Q000453:epidemiology* / Q000601:surgery; D014481:United States
keywords: allergic rhinitis; asthma; database; incidence; rhinosinusitis