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Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations.
- Source :
-
International forum of allergy & rhinology [Int Forum Allergy Rhinol] 2023 Sep; Vol. 13 (9), pp. 1758-1782. Date of Electronic Publication: 2023 Jan 18. - Publication Year :
- 2023
-
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.<br />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.<br />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.<br /> (© 2023 ARS-AAOA, LLC.)
Details
- Language :
- English
- ISSN :
- 2042-6984
- Volume :
- 13
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- International forum of allergy & rhinology
- Publication Type :
- Academic Journal
- Accession number :
- 36579899
- Full Text :
- https://doi.org/10.1002/alr.23130