Assistant Professor UT Southwestern Medical Center Dallas, Texas
Introduction: The impact of endoscopic sinus surgery (ESS) on pulmonary function (PF) in patients with cystic fibrosis (CF) is poorly understood due to conflicting results in the literature. Some patients appear to improve while others do not. This study aimed to identify differences between patients with CF whose PF improved after ESS (responders) and those that did not (non-responders).
Methods: A retrospective review was conducted on CF patients who underwent ESS between 2005 and 2017 at 3 academic institutions. Data including age, gender, preoperative PF test (PFT) data for 1 year prior and 1 year following surgery, number of exacerbations and length of antibiotics was collected. Responders were defined as patients who had improvement in both FEV1 and percent predicted FEV1 (ppFEV1) at most time points after surgery through 9-12 months.
Results: 25 responders and 52 non-responders were analyzed. Preoperatively, responders were more likely to show pulmonary decline in both FEV1 (p=0.018) and ppFEV1 (0.03) than non-responders. The responder group also had a lower pre-operative ppFEV1 than non-responders (62.5 vs 74.9, p=0.023). Post-operatively, responders showed significantly less decline over 1 year based on both the overall PFT trend for FEV1 (p < 0.0001), ppFEV1 (p < 0.0001) and average change in FEV1 (p < 0.0001) and ppFEV1 (p < 0.0001) and average change between PFTs for FEV1 (p < 0.0001) and ppFEV1 (p=0.003).
Conclusion: It is possible that some CF patients experience improvement in PF following ESS. Potential responders appear to be patients showing a greater decline in PF in the 1 year prior to ESS compared to non-responders. Further studies are needed to better understand which patients might experience improved PF after ESS