Care for Patients with Type-2 Chronic Rhinosinusitis

Giunta, Gianmarco; Pirola, Francesca; Giombi, Francesco; Muci, Giovanna; Pace, Gian Marco; Heffler, Enrico; Paoletti, Giovanni; Puggioni, Francesca; Cerasuolo, Michele; Ferreli, Fabio; Salamanca, Fabrizio; Mercante, Giuseppe; Spriano, Giuseppe; Canonica, Giorgio Walter; Malvezzi, Luca

doi:10.3390/jpm13040618

Cited by 11 publications

(5 citation statements)

References 82 publications

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“…These results confirm that the endoscopic and symptomatological differences may further turn into divergences from a psychiatric point of view, in terms of depression and anxiety. According to our evidence, we want to stress the need for a change from a “disease” to a “patient-centered” medicine, in order to improve the whole healthcare process from a holistic perspective [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study

Giombi,

Canali,

Zuppardo

et al. 2024

Cureus

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Background and objectives: Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has explored the impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. Methods: Monocentric cross-sectional observational study. Consecutive patients affected by CRS with or without nasal polyps or by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), the Sinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. Results: One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polyps and those suffering from CRS without nasal polyps or SD both in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SD compared to older. Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated. Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life (QoL) of patients affected by sinonasal conditions. According to our results, age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.

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Section: Discussionmentioning

confidence: 99%

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study

Giombi,

Canali,

Zuppardo

et al. 2024

Cureus

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“…In this scenario, it is recommended to assemble a multidisciplinary team comprising, at the very least, otolaryngologists, allergologists/clinical immunologists, pneumologists, and psychologists. This collaborative approach aims to provide the most effective diagnostic and therapeutic strategies for the patient, especially in an era where emerging therapeutic interventions, such as biologic agents, are shaping the landscape of managing type-2 related disorders of the airways [78].…”

Section: A Systemic Conditionmentioning

confidence: 99%

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Giombi,

Pace,

Pirola

et al. 2024

IJMS

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Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an “endotype-based” definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a “united airway” perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the “united airways”. It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

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“…[1][2][3][4] The clinical presentation of CRSwNP typically includes nasal congestion, rhinorrhea, facial pressure or pain, and hyposmia for 12 weeks or more. 5 While the overall burden has been reported to be comparable with other chronic diseases such as diabetes, COPD, and asthma, there are still some blind spots in the full understanding of the clinical traits of this condition. 6 The pathophysiology of CRSwNP is yet to be completely clarified, but it has been shown that its symptoms are associated with both local and systemic inflammatory processes, which may cause topical therapies to fail in permanently controlling the disease.…”

Section: Introductionmentioning

confidence: 99%

Radiological Versus Clinical 1‐Year Outcomes of Dupilumab in Refractory CRSwNP: A Real‐Life Study

Giombi,

Pace,

Nappi

et al. 2023

The Laryngoscope

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ObjectiveTo provide real‐life evidence on long‐term radiological changes in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab, and to assess possible differences between radiological and clinical results in terms of endoscopic findings and Patient‐Reported‐Outcomes (PROs).MethodsConsecutive patients treated with dupilumab for recalcitrant CRSwNP were required to undergo CT scan at baseline (T0) and after 12 (T1) since first administration. A group of patients also performed CT scan at 52 weeks (T2) to assess long‐term outcomes. At each timepoint, patients underwent nasal endoscopy, assessment of Nasal‐Polyp‐Score (NPS), Lund‐Kennedy‐Score (LKS), and had to fill in the 22‐item Sinonasal‐Outcome‐Test (SNOT‐22) and Visual‐Analogue‐Scales (VAS) for sinonasal symptoms.ResultsIn fifty‐three included patients, from T0 to T1 we detected a significant reduction in mean Lund‐Mackay score (LM), PROs (SNOT‐22, VAS) and endoscopic (NPS, LKS) scores (p < 0.05). In the subset of patients that reached T2 (n = 30), compared to T1, we observed a further significant decrease in mean LM, SNOT‐22, VAS, and NPS scores, but not in LKS (p = 0.420). At T1, the highest improvement was observed in PROs (SNOT‐22: 56.26%), and polyp size (NPS: 49.83%). Conversely, between T1 and T2, sinus opacification was shown to be the most improved outcome (LM: 36.86%).ConclusionsOur experience showed that poorly controlled CRSwNP patients treated with dupilumab experienced significant improvement in radiologic, endoscopic and clinical disease severity. While in the initial 3 months, PROs garnered attention for showing earlier effectiveness, radiological outcomes revealed sustained and gradual efficacy in a longer term.Level of EvidenceLevel 4. According to the Oxford Center for Evidence‐Based Medicine 2011 level of evidence guidelines, this non‐randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 2023

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Care for Patients with Type-2 Chronic Rhinosinusitis

Cited by 11 publications

References 82 publications

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Radiological Versus Clinical 1‐Year Outcomes of Dupilumab in Refractory CRSwNP: A Real‐Life Study

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