Bronchial asthma in combination with chronic rhinosinusitis with nasal polyps: epidemiology, prevalence and peculiarities of their relationship

Abstract

Asthma in most cases is under control due to the success of modern pharmacotherapy. At the same time questions concerning the treatment of asthma and comorbidities like chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. Among the causes of СRSwNP formation a microbial aggression or an inadequate immune response (allergy) to various types of antigens (allergens) are considered. Congenital, individual characteristics and abnormalities of the corresponding anatomical structures are also cited as factors contributing to the development of CRSwNP. A functional integrated immunity system - the lymphoid tissue associated with the mucous membranes (MALT), infectious and allergic inflammation in the upper respiratory tract can significantly affect the lower respiratory tract and vice versa. Inflammation is the cornerstone of CRSwNP pathogenesis, that’s why understanding of inflammatory response will reveal the mechanisms of asthma severity in combination with CRSwNP.

Non‐Type 2 and Mixed Inflammation in Chronic Rhinosinusitis and Lower Airway Disease

“…The mean age of these participants ranged from 9 to 72, with 96.6% ( n = 30) of articles focusing on the adult population. Five studies did not provide age information 18–22 . These studies obtained biological samples from the airway, 77.7% ( n = 21) from the upper airway, 11.1% ( n = 3) from the lower airway, and 11.1% ( n = 3) from both the upper and lower airways.…”

“…Patients diagnosed with both CRS and asthma demonstrated type 2 (40.0%, n = 8), 10,20,24–29 type 1 (7.5%, n = 1.5), 30,31 type 3 (5.0%, n = 1), 32 mixed types 1 and 2 (T1/2) (5.0%, n = 1), 33 and mixed type 1, 2, and 3 (T1/2/3) (42.5%, n = 8.5) 11,14,18,19,30,34–37 endotype shifts in upper and lower airway samples (Table I) (Fig. 1).…”

“…This includes the T1/2 ( n = 1) endotype demonstrated by Riccio et al 33 with elevations in IL4, IL‐6, IL‐8, and IL‐1B from rhinonasal lavage. The T1/2/3 endotype was particularly prevalent ( n = 8.5), with the following biomarkers being elevated by 3 or more T1/2/3 studies; type 2 markers (IL‐5, IL‐13, and eosinophils), type 1 markers (IL‐6, MPO, TNF‐alpha, and IFN‐gamma) and the type 1/3 marker, neutrophils 11,14,18,19,30–37 . The T1/2/3 endotype shift was more prevalent in patients residing in Asia or Russia, due to 44.4% (4/9) and 100% (2/2) of studies in each respective location demonstrating a T1/2/3 endotype shift (Fig.…”

“…The cause for this geographical difference in endotype proportions could be related to the unique weather, pollen, and pollution 46,47 . Lastly, atopy is commonly associated with type 2 inflammation, but there is mixed evidence regarding its prevalence in patients with a T1/2/3 mixed endotype 18,19,33,37 . Furthermore, the factors impacting non‐type 2 and mixed endotypes in patients with CRS and asthma is a novel area of study that requires more attention.…”

“…Five studies did not provide age information. [18][19][20][21][22] These studies obtained biological samples from the airway, 77.7% (n = 21) from the upper airway, 11.1% (n = 3) from the lower airway, and 11.1% (n = 3) from both the upper and lower airways. Among upper airway samples, material included sinonasal mucosa (n = 15), nasal polyps (n = 3), nasal secretions (n = 2), and rhinonasal lavage (n = 1).…”