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\begin{document}

\title{Correspondence to ``Association between Chronic Rhinosinusitis and New
Onset Asthma Implications for Prevention''}



\author[1]{Iressa Cheng}%
\author[2]{Chin-Yuan Yii}%
\author[3]{Su-Boon  Yong}%
\author[4]{Liang-Chun Shih}%
\affil[1]{Chung Shan Medical University College of Medicine}%
\affil[2]{Taiwan Landseed Hospital Library}%
\affil[3]{China Medical University College of Medicine}%
\affil[4]{China Medical University College of Pharmacy}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\textbf{Correspondence to ``Association between Chronic Rhinosinusitis
and New Onset Asthma Implications for Prevention''}

To the Editor,

We have attentively reviewed the article by Schwartz et al. titled
'Sinus inflammation and chronic rhinosinusitis are associated with a
diagnosis of new onset asthma in the following year'\textsuperscript{1}.
This study significantly advances our understanding of the relationship
between chronic rhinosinusitis (CRS) and the onset of new asthma
diagnoses. However, we would like to offer some suggestions.

First and foremost, it is important to consider potential confounders
that might influence the observed association between CRS and the
development of asthma. Factors such as environmental exposures or
socio-economic status could potentially impact this
relationship.\textsuperscript{2,3}

Secondly, this study focuses on the CRS-asthma association but doesn't
probe how CRS treatments affect asthma outcomes. Phillips et
al\textsuperscript{4}showed timely CRS treatments, such as functional
endoscopic sinus surgery (FESS) might lower asthma risks. Addressing
eosinophilic inflammation and related conditions, e.g. depression, could
also influence asthma results\textsuperscript{5,6}. Understanding CRS
treatment impacts on asthma is crucial for patient care, necessitating
more research to inform clinical guidance.

Furthermore, it's important to consider that this study might have
overestimated the connection between chronic rhinosinusitis (CRS) and
asthma due to certain methodological limitations. The study did not take
into account the 12-week duration requirement for CRS, potentially
leading to an overrepresentation of cases and an overestimation of the
associations~. Additionally, the reliance on electronic health records
(EHR) for identifying disease outcomes introduces the possibility of
measurement errors or biases, which could further contribute to the
overestimation of the observed associations~. Therefore, it is crucial
for future research endeavors to refine their methods and address these
limitations in order to obtain a more accurate understanding of the
strength of the CRS-asthma association.

In conclusion, this study by Schwartz et al.'s research highlights a
link between CRS and new asthma cases, but further exploration is needed
on potential confounders, the effect of CRS treatments, and potential
overestimations.

1. Schwartz BS, Pollak JS, Bandeen-Roche K, et al. Sinus inflammation
and chronic rhinosinusitis are associated with a diagnosis of new onset
asthma in the following year. \emph{Allergy} . Oct
2023;78(10):2659-2668. doi:10.1111/all.15771

2. Celebi Sozener Z, Cevhertas L, Nadeau K, Akdis M, Akdis CA.
Environmental factors in epithelial barrier dysfunction. \emph{J Allergy
Clin Immunol} . Jun 2020;145(6):1517-1528.
doi:10.1016/j.jaci.2020.04.024

3. Velasquez N, Gardiner L, Cheng TZ, et al. Relationship between
socioeconomic status, exposure to airborne pollutants, and chronic
rhinosinusitis disease severity. \emph{Int Forum Allergy Rhinol} . Feb
2022;12(2):172-180. doi:10.1002/alr.22884

4. Phillips KM, Bergmark RW, Hoehle LP, Caradonna DS, Gray ST, Sedaghat
AR. Chronic rhinosinusitis exacerbations are differentially associated
with lost productivity based on asthma status. \emph{Rhinology} . Dec 1
2018;56(4):323-329. doi:10.4193/Rhin18.033

5. Shah SA, Kobayashi M. Pathogenesis of chronic rhinosinusitis with
nasal polyp and a prominent T2 endotype. \emph{Heliyon} . Sep
2023;9(9):e19249. doi:10.1016/j.heliyon.2023.e19249

6. Brunner WM, Schreiner PJ, Sood A, Jacobs DR, Jr. Depression and risk
of incident asthma in adults. The CARDIA study. \emph{Am J Respir Crit
Care Med} . May 1 2014;189(9):1044-51. doi:10.1164/rccm.201307-1349OC

Author

Iressa Cheng \textsuperscript{1}, Chin-Yuan Yii MD\textsuperscript{2,3}.
Su-Boon Yong\textsuperscript{4,5},Liang-Chun Shih MD, PhD
\textsuperscript{4,6}

1 School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

2 Division of Gastroenterology and Hepatology, Department of Internal
Medicine, Landseed International Hospital, Taoyuan, Taiwan;

3 Department of Biomedical Sciences and Engineering, National Central
University, Taoyuan, Taiwan.

4 Department of Medicine, College of Medicine, China Medical University,
Taichung, Taiwan.

5 Department of Allergy and Immunology, China Medical University
Children's Hospital, Taichung, Taiwan.

6 Department of Otorhinolaryngology-Head and Neck Surgery

Author Contributions:

Iressa Cheng: Conceptualization, Writing - Original Draft Preparation

Chin-Yuan Yii: Conceptualization, Writing - Review \& Editing

Liang-Chun Shih: Writing - Review \& Editing

Jiu Yao Wang: Conceptualization, Writing - Review \& Editing,
Supervision

Su-Boon Yong: Conceptualization, Writing - Review \& Editing,
Supervision, Project Administration

conflict of interests :

The authors declare no conflict of interest.

Corresponding author:

1.Su-Boon Yong MD, PhD.

Department of Medicine, College of Medicine, China Medical University,
Taichung, Taiwan.

Department of Allergy and Immunology, China Medical University
Children's Hospital, Taichung, Taiwan.

yongsuboon@gmail.com

2. Jiu Yao Wang MD, PhD

Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical
University Hospital, Taichung, Taiwan, China.

Department of Allergy, Immunology, and Rheumatology (AIR), China Medical
University Children's Hospital, Taichung, Taiwan, China.

a122@mail.ncku.edu.tw

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