Review Article| Volume 56, ISSUE 1, P169-179, February 2023

Unified Airway Disease

Surgical Management


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        • Meena R.S.
        • Meena D.
        • Aseri Y.
        • et al.
        Chronic rhino-sinusitis and asthma: concept of unified airway disease (UAD) and its impact in otolaryngology.
        Indian J Otolaryngol Head Neck Surg. 2013; 65: 338-342
        • Kicic A.
        • de Jong E.
        • Ling K.-M.
        • et al.
        Assessing the unified airway hypothesis in children via transcriptional profiling of the airway epithelium.
        J Allergy Clin Immunol. 2020; 145: 1562-1573
        • Bachert C.
        • Vignola A.M.
        • Gevaert P.
        • et al.
        Allergic rhinitis, rhinosinusitis, and asthma: one airway disease.
        Immunol Allergy Clin N Am. 2004; 24: 19-43
        • Chanez P.
        • Vignola A.M.
        • Vic P.
        • et al.
        Comparison between nasal and bronchial inflammation in asthmatic and control subjects.
        Am J Respir Crit Care Med. 1999; 159: 588-595
        • Gaga M.
        • Lambrou P.
        • Papageorgiou N.
        • et al.
        Eosinophils are a feature of upper and lower airway pathology in non-atopic asthma, irrespective of the presence of rhinitis.
        Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2000; 30: 663-669
        • Ryu G.
        • Min C.
        • Park B.
        • et al.
        Bidirectional association between asthma and chronic rhinosinusitis: two longitudinal follow-up studies using a national sample cohort.
        Sci Rep. 2020; 10: 9589
        • Braunstahl G.J.
        • Kleinjan A.
        • Overbeek S.E.
        • et al.
        Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients.
        Am J Respir Crit Care Med. 2000; 161: 2051-2057
        • Braunstahl G.J.
        • Overbeek S.E.
        • Kleinjan A.
        • et al.
        Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways.
        J Allergy Clin Immunol. 2001; 107: 469-476
        • Benninger M.S.
        • Sindwani R.
        • Holy C.E.
        • et al.
        Impact of medically recalcitrant chronic rhinosinusitis on incidence of asthma.
        Int Forum Allergy Rhinol. 2016; 6: 124-129
        • Soler Z.M.
        • Wittenberg E.
        • Schlosser R.J.
        • et al.
        Health state utility values in patients undergoing endoscopic sinus surgery.
        Laryngoscope. 2011; 121: 2672-2678
        • Piccirillo J.F.
        • Edwards D.
        • Haiduk A.
        • et al.
        Psychometric and clinimetric validity of the 31-item rhinosinusitis outcome measure (RSOM-31).
        Am J Rhinol. 1995; 9: 297-308
        • Soler Z.M.
        • Smith T.L.
        Quality of life outcomes after functional endoscopic sinus surgery.
        Otolaryngol Clin North Am. 2010; 43: 605-x
        • Senior B.A.
        • Glaze C.
        • Benninger M.S.
        Use of the rhinosinusitis disability index (RSDI) in rhinologic disease.
        Am J Rhinol. 2001; 15: 15-20
        • Juniper E.F.
        • Thompson A.K.
        • Ferrie P.J.
        • et al.
        Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire.
        J Allergy Clin Immunol. 1999; 104: 364-369
        • Smith T.L.
        • Kern R.C.
        • Palmer J.N.
        • et al.
        Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study.
        Int Forum Allergy Rhinol. 2011; 1: 235-241
        • Kennedy J.L.
        • Hubbard M.A.
        • Huyett P.
        • et al.
        Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis.
        Ann Allergy Asthma Immunol. 2013; 111: 246-251.e2
        • Bachert C.
        • Mannent L.
        • Naclerio R.M.
        • et al.
        Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial.
        JAMA. 2016;
        • Psaltis A.J.
        • Li G.
        • Vaezeafshar R.
        • et al.
        Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures.
        Laryngoscope. 2014; 124: 2216-2223
        • Lund V.J.
        • Kennedy D.W.
        Staging for rhinosinusitis.
        Otolaryngol Neck Surg. 1997; 117: S35-S40
        • Juniper E.F.
        • O’byrne P.M.
        • Guyatt G.H.
        • et al.
        Development and validation of a questionnaire to measure asthma control.
        Eur Respir J. 1999; 14: 902-907
        • Nathan R.A.
        • Sorkness C.A.
        • Kosinski M.
        • et al.
        Development of the asthma control test: a survey for assessing asthma control.
        J Allergy Clin Immunol. 2004; 113: 59-65
        • Juniper E.F.
        • Buist A.S.
        • Cox F.M.
        • et al.
        Validation of a standardized version of the Asthma Quality of Life Questionnaire.
        Chest. 1999; 115: 1265-1270
        • van Veen I.H.
        • Ten Brinke A.
        • Sterk P.J.
        • et al.
        Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma.
        Eur Respir J. 2008; 32: 344-349
        • Smith K.A.
        • Smith T.L.
        • Mace J.C.
        • et al.
        Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis.
        Int Forum Allergy Rhinol. 2014; 4: 823-827
        • Smith T.L.
        • Schlosser R.J.
        • Mace J.C.
        • et al.
        Long-term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis.
        Int Forum Allergy Rhinol. 2019; 9: 831-841
        • Lourijsen E.S.
        • Reitsma S.
        • Vleming M.
        • et al.
        Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial.
        Lancet Respir Med. 2022; 2600: 1-10
        • Patel Z.M.
        • Thamboo A.
        • Rudmik L.
        • et al.
        Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis.
        Int Forum Allergy Rhinol. 2017; 7: 119-127
        • Vashishta R.
        • Soler Z.M.
        • Nguyen S.A.
        • et al.
        A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis.
        Int Forum Allergy Rhinol. 2013; 3: 788-794
        • Schlosser R.J.
        • Smith T.L.
        • Mace J.
        • et al.
        Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis.
        Allergy. 2017; 72: 483-491
        • Cao Y.
        • Hong H.
        • Sun Y.
        • et al.
        The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis.
        Eur Arch Otorhinolaryngol. 2019; 276: 1405-1411
        • Mullol J.
        • Maldonado M.
        • Castillo J.A.
        • et al.
        Management of United Airway disease focused on patients with asthma and chronic rhinosinusitis with nasal polyps: a systematic review.
        J Allergy Clin Immunol Pract. 2022;
        • Hamada K.
        • Oishi K.
        • Chikumoto A.
        • et al.
        Impact of sinus surgery on type 2 airway and systemic inflammation in asthma.
        J Asthma. 2021; 58: 750-758
        • Lee T.-J.
        • Fu C.-H.
        • Wang C.-H.
        • et al.
        Impact of chronic rhinosinusitis on severe asthma patients.
        PLoS One. 2017; 12: e0171047
        • Terada T.
        • Inui T.
        • Moriyama K.
        • et al.
        Effects of endoscopic sinus surgery for eosinophilic chronic rhinosinusitis on respiratory functions and FeNO production in the lower respiratory tract.
        Ear Nose Throat J. 2021; (1455613211032006)
        • Farraia M.
        • Paciência I.
        • Castro Mendes F.
        • et al.
        Allergen immunotherapy for asthma prevention: a systematic review and meta-analysis of randomized and non-randomized controlled studies.
        Allergy. 2022; 77: 1719-1735
        • Wei L.
        • Zhang Y.
        • Tan H.
        Changes of TNF-α, PDGF and HA in nasal secretions and olfactory function of patients with chronic sinusitis before and after endoscopic sinus surgery.
        Exp Ther Med. 2018; 16: 3413-3418
        • Du K.
        • Huang Z.
        • Si W.
        • et al.
        Dynamic change of t-helper cell cytokines in nasal secretions and serum after endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps.
        ORL J Otorhinolaryngol Relat Spec. 2020; 82: 74-85
        • Zhao Y.
        • Jiang C.
        • Wu Q.
        • et al.
        Effects of endoscopic sinus surgery combined with budesonide treatment on nasal cavity function and serum inflammatory factors in patients with chronic sinusitis.
        J Healthc Eng. 2022; 2022: 4140682
        • Lal D.
        • Baroody F.M.
        • Weitzel E.K.
        • et al.
        Total IgE levels do not change 1 year after endoscopic sinus surgery in patients with chronic rhinosinusitis.
        Int Arch Allergy Immunol. 2006; 139: 146-148
        • Kanemitsu Y.
        • Kurokawa R.
        • Ono J.
        • et al.
        Increased serum periostin levels and eosinophils in nasal polyps are associated with the preventive effect of endoscopic sinus surgery for asthma exacerbations in chronic rhinosinusitis patients.
        Int Arch Allergy Immunol. 2020; 181: 862-870
        • Aroor R.
        • Sunu Ali Z.
        • Gangadhara Somayaji K.S.
        Do nasal surgeries affect mucociliary clearance?.
        Indian J Otolaryngol Head Neck Surg. 2017; 69: 24-28
        • Alekseenko S.
        • Karpischenko S.
        • Artyushkin S.
        • et al.
        Ciliary function and sinonasal mucosal cytology in pediatric patients with chronic rhinosinusitis during a year after functional endoscopic sinus surgery.
        Rhinology. 2021; 59: 319-327
        • Macdonald K.I.
        • Gipsman A.
        • Magit A.
        • et al.
        Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function.
        Rhinology. 2012; 50: 360-369
        • Yin M.
        • Gao X.
        • Di L.
        • et al.
        Effect of endoscope sinus surgery on pulmonary function in cystic fibrosis patients: a meta-analysis.
        Laryngoscope. 2021; 131: 720-725
        • Vital D.
        • Hofer M.
        • Benden C.
        • et al.
        Impact of sinus surgery on pseudomonal airway colonization, bronchiolitis obliterans syndrome and survival in cystic fibrosis lung transplant recipients.
        Respiration. 2013; 86: 25-31
        • Johnson J.R.
        • Hwang P.H.
        • Nayak J.V.
        • et al.
        Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis.
        Int Forum Allergy Rhinol. 2022; 12: 821-827
        • Khalfoun S.
        • Tumin D.
        • Ghossein M.
        • et al.
        Improved lung function after sinus surgery in cystic fibrosis patients with moderate obstruction.
        Otolaryngol Neck Surg. 2018; 158: 381-385
        • Adelman J.
        • McLean C.
        • Shaigany K.
        • et al.
        The role of surgery in management of Samter’s triad: a systematic review.
        Otolaryngol Neck Surg. 2016; 155: 220-237
        • Jerschow E.
        • Edin M.L.
        • Chi Y.
        • et al.
        Sinus surgery is associated with a decrease in aspirin-induced reaction severity in patients with aspirin exacerbated respiratory disease.
        J Allergy Clin Immunol Pract. 2019; 7: 1580-1588
        • Huang G.X.
        • Palumbo M.L.
        • Singer J.I.
        • et al.
        Sinus surgery improves lower respiratory tract reactivity during aspirin desensitization for AERD.
        J Allergy Clin Immunol Pract. 2019; 7: 1647-1649
        • Kanjanaumporn J.
        • Hwang P.H.
        Effect of endoscopic sinus surgery on bronchiectasis patients with chronic rhinosinusitis.
        Am J Rhinol Allergy. 2018; 32: 432-439
        • Jura-Szołtys E.
        • Ficek R.
        • Ficek J.
        • et al.
        Bronchial asthma control after argon plasma coagulation turbinectomy in patients with chronic rhinitis.
        Eur Arch Otorhinolaryngol. 2014; 271: 1581-1587
        • Unsal O.
        • Ozkahraman M.
        • Ozkarafakili M.A.
        • et al.
        Does the reduction of inferior turbinate affect lower airway functions?.
        Braz J Otorhinolaryngol. 2019; 85: 43-49