A personalized approach to medical rehabilitation for patients with rhinosinusitis with nasal polyps and comorbid asthma

Abstract

BACKGROUND: Personalized medical rehabilitation options are required for patients with chronic rhinosinusitis with nasal polyps owning to the relatively high prevalence of this disease, its long and often uncontrolled course, and the significant decrease in quality of life of patients. Comorbid asthma is common in patients with rhinosinusitis with nasal polyps and is associated with more severe clinical manifestations and increased unresponsiveness to therapy, reducing the effectiveness of rehabilitation efforts. AIM: The aim of the study was to identify predictors of personalized comprehensive rehabilitation options to be used in patients with rhinosinusitis with nasal polyps and comorbid asthma in order to achieve greater clinical effectiveness of therapy and control of nasal polyps. MATERIALS AND METHODS: The study was conducted in 35 patients with rhinosinusitis with nasal polyps and comorbid asthma. Comprehensive medical rehabilitation included endonasal use of Nasonex 2 doses twice daily; nasal rinsing twice daily; subcutaneous use of dupilumab at 300 µg every 2 weeks; use of low-dose inhaled corticosteroid (beclomethasone dipropionate at 200 µg twice daily); a course of alternating magnetic field therapy, low-intensity laser radiation, and interval hypoxic training. At baseline, nasal polyp severity, respiratory function, quality of life, and levels of cytokines, immunoglobulins, leukocytes, lymphocytes, and eosinophils were assessed. The effectiveness of rehabilitation measures was assessed 6 months after the start of treatment using the International Classification of Functioning, Disability, and Health criteria. RESULTS: Using multiple regression analysis, an information model was developed to predict effectiveness of comprehensive medical rehabilitation in patients with rhinosinusitis with nasal polyps and comorbid asthma. The resulting attribute of the model was the final score of the seven selected domains of the International Classification of Functioning, Disability, and Health. A cluster of baseline clinical and laboratory variables was identified as predictors, including blood eosinophil level, blood tumor necrosis factor-alpha (TNF-alpha) level, total score for a 22-item Sino-Nasal Outcome Test (SNOT-22) functional domain, and forced expiratory volume in one second. Higher level of rehabilitation was achieved with the following baseline characteristics: blood eosinophil counts no more than 0.85 × 109/L; blood TNF-α level no more than 18.0 pg/mL; total score for the SNOT-22 functional domain no more than 8; forced expiratory volume in one second no less than 2.6 L. CONCLUSION: At baseline, the identified thresholds of the selected predictors predict the outcome that could be achieved for each patient who receives personalized comprehensive rehabilitation.