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ABSTRACT Background Precedent chronic rhinosinusitis (CRS) is associated with new‐onset asthma and non‐cystic fibrosis bronchiectasis (BE). Objective To assess if endoscopic sinus surgery (ESS) mitigates the development of lower airway diseases in patients with CRS. Methods This retrospective study utilized electronic medical records from an academic center. CRS patients ( > 18 years old) without asthma or BE, were identified between January 2006 and December 2013. Charts were reviewed until May 2023. New diagnoses of asthma or BE were identified in patient records following ESS before December 2018 compared to patients without ESS. Lund–Mackay (LM) scores were calculated in a random subset of patients to assess disease severity. Logistic regression was used to estimate the odds of developing asthma or BE by ESS status. Results A total of 1877 patients underwent ESS, while 13,453 did not. CRS severity was higher in the ESS group (LM, 9.02) versus no ESS group (LM, 4.28). After up to 17 years of follow‐up, 207/1877 (11%) and 40/1877 (2.1%) of patients with ESS had a new asthma or BE diagnosis, respectively. Out of 13,453 patients, 1778 (13.2%) and 293 (2.2%) patients without ESS had a new asthma or BE diagnosis. The unadjusted odds of a new asthma diagnosis were lower by 19% for ESS versus no ESS; OR (95% CI), 0.81 (0.70–0.95). After controlling for confounders (age, gender, race/ethnicity, smoking status, and chronic rhinitis), the association remained significant, with a 15% reduction in the odds of a new asthma diagnosis; OR (95% CI), 0.85 (0.73–0.99). There was no association between ESS status and a new diagnosis of BE. Conclusions Despite higher CRS severity, patients undergoing ESS had a lower risk of a new asthma diagnosis and did not have a higher risk of developing BE.
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