Treatment for septal deviation may lower incidence of asthma

Septal deviation may be a treatable trait of asthma, with septoplasty reducing the risk, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

“Severe cases of nasal obstruction due to [septal deviation (SD)] can lead to snoring and sleep apnea,” researchers of the study wrote. “In addition, severe SD affects the physiology of the nasal cavity and causes mucosal and neurological changes; however, information is scarce regarding the impact of SD on lower respiratory tract pathophysiology.”

Based on data that may suggest relationships between upper respiratory tract disorders and asthma, the researchers investigated the potential impact of SD and the incidence of asthma as well as the outcomes of surgical correction with septoplasty.

The study comprised 29,853 individuals from Korea with SD (n = 9,951) and those without as controls (n = 19,902), with no significant imbalances between the two groups. The researchers followed the subjects for 9 years between January 2005 and December 2013.

The incidence for asthma was significantly higher for those with SD (adjusted HR = 2.43; 95% CI, 2.31-2.56).

Of those with SD, 1,526 received septoplasty between 2002 and 2004. Results from a follow-up in 2013 showed a lowered rate of asthma with septoplasty in the SD group (aHR = 0.83; 95% CI, 0.75-0.93).

The researchers noted that among patients with SD, there were also high incidences for allergic rhinitis (aHR = 1.58; 95% CI, 1.5-1.67) and chronic rhinosinusitis (aHR = 1.22; 95% CI, 1.15-1.31).

“In the pathobiological context, when airflow dynamics are altered in SD patients, histological changes such as squamous metaplasia and infiltration of inflammatory cells can be observed in the nasal mucosa,” the researchers wrote. “These changes can affect mucociliary clearance and production of mucus through the airways, which may lead to a chronic inflammatory condition in the airways typically observed in asthma.”

From this, they wrote that the common association between SD and asthma — observed in 20% to 30% of patients — may impact diagnosis or complicate treatment.

“Septoplasty was associated with a reduced incidence of asthma, which provides evidence for surgical correction to control the development of this condition in SD patients,” the researchers concluded. “Further research is necessary to elucidate the relationship between SD and asthma, and intervention studies will be required to confirm a relationship between septoplasty and subsequent asthma development.”