Executive Summary of EPOS 2020 Including Integrated Care Pathways

Abstract

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012 (1-3). The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence

Epithelial barriers in allergy and asthma

“…The heterogeneity of disease endotypes, the time-consuming and costly nature of primary epithelial cultures, and challenges in interpretation of in vitro study results 67 or translating murine findings to human diseases have all resulted in the lack of inclusion of nasal and bronchial epithelial barrier function in the guidelines for diagnostic work-out of patients affected by (allergic) rhinitis, CRS, and/or asthma. 68 The lack of commercially available tools to diagnose epithelial barrier dysfunction in the human airways, and the limited knowledge on the function of distinct epithelial cells, hampers the implementation of the airway epithelial barrier in clinical practice.…”

Expression of Estrogen Receptor-alpha in Nasal Polyps and the Effects of Dexamethasone on Estrogen Receptor-alpha Expression in RPMI 2650 Cells

“…Glucocorticoids, such as dexamethasone, are drugs used for the first-line treatment of CRS with NPs to suppress nasal inflammation. 3 The clinical efficacy of glucocorticoids for treating NPs results from the induction of apoptosis in both eosinophils and T-lymphocytes that infiltrate NPs and the downregulation of epithelial GM-CSF production, which prolongs eosinophil survival. 4…”

“…Glucocorticoids, including dexamethasone, are the most widely prescribed antiinflammatory drugs and are the only currently available treatment option with proven efficacy for NPs. 3 According to previous reports, glucocorticoids increase apoptosis in various inflammatory cells including eosinophils, fibroblasts, and nasal epithelial cells. [4][5][6] Estrogen (17β-estradiol) is known to regulate the expression of genes involved in cell survival, proliferation, differentiation, and reproduction, 7 through binding to its receptors (ERs), ER-α, ER-β.…”

Montelukast Has no Impact on the Systemic Production of TGFβ-1 in Patients with Nasal Polyposis Associated with Aspirin Intolerance

“…The sample comprised 48 individuals with a European Position (EPOS) 2012 13 diagnosis of NP, and 15 healthy controls for comparison of the baseline TGF-β1 levels in the peripheral blood.…”