Asthma Outcomes Following Early Versus Delayed Sinus Surgery in CRSwNP

CLINICAL QUESTION

Is early endoscopic sinus surgery (ESS) associated with improved long-term asthma outcomes compared with delayed surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)?

BOTTOM LINE

Early ESS (six months or less after CRSwNP diagnosis) was associated with lower rates of moderate and severe persistent asthma, fewer asthma exacerbations, and reduced utilization of systemic steroids, long-acting ß₂-agonists (LABAs), and biologic therapies compared with delayed surgery.

BACKGROUND: CRSwNP commonly coexists with asthma and reflects interconnected upper and lower airway inflammation. Prior studies have demonstrated that ESS improves asthma-related symptoms, quality of life, and medication use, but the influence of surgical timing on long-term asthma morbidity has remained unclear.

STUDY DESIGN: Retrospective propensity score-matched cohort study using the TriNetX Research Network. Adults with CRSwNP who underwent ESS were categorized into early surgery (six months or less after diagnosis) or delayed surgery (one to three years after diagnosis) cohorts. Patients undergoing surgery between six and 12 months were excluded to maintain clearly distinct groups. Outcomes were assessed over a five-year follow-up period.

SETTING: TriNetX global federated electronic health record research network, including 107 healthcare organizations and more than 100 million patients

SYNOPSIS: Investigators identified 27,519 patients who underwent early ESS and 3,928 patients who underwent delayed ESS. After 1:1 propensity score matching based on demographics, asthma severity, and asthma medication utilization, 3,683 patients remained in each cohort with balanced baseline characteristics and a similar follow-up duration (~3.6 years).

The incidence of new asthma diagnoses did not differ significantly between groups (10.8% early versus 10.9% delayed; odds ratio, OR 0.99; P=0.89). Early ESS was associated with lower rates of moderate persistent asthma (11.5% versus 13.5%; OR 0.84; P=0.012) and severe persistent asthma (6.5% versus 8.4%; OR 0.76; P=0.003), however. Patients undergoing early surgery also experienced fewer asthma exacerbations during follow-up (6.4% versus 8.1%; OR 0.78; P=0.005).

Medication utilization differed significantly between cohorts. Early ESS was associated with lower use of LABAs (23.7% versus 29.4%; OR 0.75; P<0.001), corticosteroids (63.7% versus 67.4%; OR 0.85; P=0.0009), and biologic therapies (7.7% versus 10.1%; OR 0.74; P=0.0004). The early surgery cohort also demonstrated lower final recorded absolute eosinophil counts during follow-up (372 versus 618 cells/µL; P=0.04).

The authors suggest that earlier ESS may be associated with reduced asthma morbidity and lower long-term treatment burden in patients with CRSwNP. Limitations include the retrospective design, potential residual confounding, lack of pulmonary function testing and validated asthma control scores, inability to determine corticosteroid administration route, and absence of detailed CRS severity metrics such as Lund–Mackay scores. Additionally, biologic and corticosteroid use may reflect treatment of either asthma or CRSwNP severity.

CITATION: Oliver JR, et al. Asthma outcomes following early versus delayed sinus surgery in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2026;16:477-483. doi:10.1002/alr.70091.

COMMENT: While the impact of CRSwNP on asthma control is well-established, and ESS can improve asthma control and outcomes, this study looks further into the timing of ESS for CRSwNP in relation to future asthma control. Using a retrospective database evaluation, the authors find that patients undergoing early ESS (fewer than six months from diagnosis) demonstrated a lower risk of moderate and severe persistent asthma compared with those who underwent late ESS (more than 12 months). These early ESS patients also had fewer asthma exacerbations as well as less need for LABAs, steroids, and biologics. The publication suffers from the methodological limitations inherent to a database study, but may provide further support when counseling patients on the role of surgery to control their inflammatory disease—not just whether to proceed with surgery, but also a timeframe.—Ashoke Khanwalkar, MD