The Role of Surgery in Treating Nasal Obstruction to Control Asthma

Figures & data

Table 1 Clinical Characteristics of the Study Population

		ACT Improvement		P value^#
	Total	Yes	No
Cases (n)	28	13	11
Age (years)	54.3 ± 2.7	58.4 ± 3.4	53.3 ± 3.8	0.384
Male: Female (n: n)	21: 7	9: 4	9: 2	0.478
Atopy (n)	11	3	8	0.015^†
Serum IgE (IU/mL)	234.4 ± 83.9	230.4 ± 122.6	307.4 ± 158.6	0.235
SNOT-22 score	54.7 ± 5.3	59.7 ± 7.7	51.6 ± 8.4	0.582
ACT score	20.7 ± 0.9	17.9 ± 1.6	24.7 ± 0.2	<0.001*
FVC (%) predicted	79.2 ± 3.7	76.2 ± 5.5	85.1 ± 6.6	0.297
FEV1 (%) predicted	68.5± 4.2	60.9± 6.0	77.7± 6.3	0.046*
FEV1/FVC (%) predicted	84.1 ± 3.4	78.2 ± 4.8	86.6 ± 4.4	0.222
Anti-asthma medication (n)				0.148
Step 1 (as-needed SABA)	0	0	0
Step 2 (low dose ICS)	9	2	7
Step 3 (low dose ICS + LABA)	7	5	2
Step 4 (medium/high dose ICS + LABA)	5	3	2
Step 5 (anti-IgE or OCS)	3	3	0

Notes: Data presented as mean ± standard error unless otherwise indicated. ^#Comparison between patients with and without Asthma Control Test (ACT) improvement after surgery; ^†p < 0.05 (chi-squared test); *p < 0.05 (Mann–Whitney U-test).

Abbreviations: IgE, immunoglobulin E; SNOT-22, Sino-Nasal Outcome Test-22; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 s; SABA, short-acting beta₂-agonist; ICS, inhaled corticosteroid; LABA, long-acting beta₂-agonist; OCS, oral corticosteroid.

Figure 1 A strong correlation was observed between the Asthma Control Test (ACT) and Sino-Nasal Outcome Test-22 (SNOT-22) scores preoperatively (A) and 3 months postoperatively (B). ACT score was also well correlated with the predicted forced expiratory volume in 1 s (FEV1) (C), but not with total serum immunoglobulin (IgE) level (D). *p < 0.05; **p < 0.001 (Spearman correlation).

Figure 2 Nasal surgery improved sinonasal symptoms (A), but not asthma control (B) and the use of anti-asthma medication (C). The symbols represented patients with the same step of anti-asthma medication were overlapped. **p < 0.001 (Wilcoxon signed-rank test).

Abbreviations: SNOT-22, Sino-Nasal Outcome Test-22; ACT, Asthma Control Test; Pre-op, preoperative; Post-op, postoperative.

Figure 3 There was no significant difference between preoperative (pre-op) and postoperative (post-op) results of pulmonary function testing, including predicted forced vital capacity (FVC) (A), forced expiratory volume in 1 s (FEV1) (B) and FEV1/FVC (C).

Figure 4 The change in Asthma Control Test (ACT) scores were inversely correlated with the preoperative (pre-op) ACT score (A). When compared between patients with and without improvement in ACT after surgery, patients with postoperative ACT improvement had a worse pre-op ACT score (B) and predicted forced expiratory volume in 1 s (FEV1) (C). There was no difference in pre-op Sino-Nasal Outcome Test-22 (SNOT-22) score (D). *p < 0.05; **p < 0.001 (Spearman correlation and Mann–Whitney U-test).