title: Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis.
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.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Schlosser
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mace
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Soler
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D012220:Rhinitis / Q000453:epidemiology* / Q000601:surgery; D057566:Self Report; D012720:Severity of Illness Index; D012852:Sinusitis / Q000453:epidemiology* / Q000601:surgery
keywords: asthma; chronic rhinosinusitis; endoscopic sinus surgery; quality of life