Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations

Amarbir S. Gill, Jeremiah A. Alt, Kara Y. Detwiller, Nicholas R. Rowan, Stacey T. Gray, Peter W. Hellings, Shyam R. Joshi, Jivianne T. Lee, Zach M. Soler, Bruce K. Tan, Jennifer L. Taylor-Cousar, Sarah K. Wise, Tara J. Wu, Daniel M. Beswick*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Background: Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence-based management strategies for CRS in this population. Methods: Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full-text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit-harm assessments, as well as value judgment and recommendations, were provided. Results: Strong evidence confirms the benefit of oral and topical medications on sinonasal-specific outcomes in individuals with CRSwA; there is low-grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal- and asthma-specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal- and asthma-specific outcomes. Conclusion: Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second-line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status.

Original languageEnglish (US)
Pages (from-to)1758-1782
Number of pages25
JournalInternational Forum of Allergy and Rhinology
Volume13
Issue number9
DOIs
StatePublished - Sep 2023

Keywords

  • asthma
  • chronic rhinosinusitis
  • endoscopic sinus surgery
  • evidence-based review
  • medical treatment of chronic rhinosinusitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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