Managing chronic rhinosinusitis in severe asthma

Abstract

Purpose of review Over half of all patients with severe asthma have chronic rhinosinusitis (CRS). Although distinct and specialized in function and form, the upper and lower airways share similar and inter-related pathophysiologic mechanisms. The severity of CRS particularly in patients with nasal polyps can correlate with that of asthma and vice versa. The purpose of this review is to elucidate the relationship between these conditions and summarize key elements in the management of these patients. Recent findings Several advances have been made in the evaluation and treatment of patients with CRS and asthma. Further understanding of inflammatory endotypes common to both CRS and severe asthma hopefully will provide appropriate and effective treatments and improve patient outcomes. Summary CRS significantly impairs quality of life, and therapies are targeted toward improving patient symptoms, and hopefully in the future, treating the underlying immune dysfunction. Management of CRS and severe asthma requires a multidisciplinary approach. Further real-world studies are necessary to determine the best treatment algorithm for these patients.

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

“…Nasal comorbidity has to be always assessed as it could be associated with different features of asthma [ 44 ] and the presence of CRSwNP is related with increased asthma exacerbation frequency, representing a predictor of future exacerbations [ 7 ]. CRSwNP and comorbid asthma are also associated with poorly controlled asthma [ 6 ] Therefore, a patient evaluation by ENT specialist is crucial in order to assess nasal symptoms and to verify related treatment adherence (e.g., corticosteroids). As already discussed in the previous patient profile, SNOT-22 score and visual analogic scale (VAS) questionnaire may be useful in order to evaluate patient QoL together with nasal symptoms impact [ 14 ].…”

“…In fact, CRSwNP and severe asthma are more frequently associated (57.1–62%) compared with mild asthma (38–42.9%) [ 4 , 5 ]. Furthermore, the prevalence of CRSwNP in severe asthma patients is variable across country regions [ 6 , 7 ].…”

“…In recent years, it has been highlighted a correlation between type-2 inflammation and different manifestations of CRSwNP with severe asthma [ 6 ]. Indeed, in more than half of all severe asthmatics and the majority of CRSwNP cases, type-2 inflammation has been detected [ 6 , 7 ].…”

Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics

“…We suggest that rhinology centres where patients with uncontrolled, severe CRSwNP are followed should establish direct collaborative networks with pulmonologists to facilitate pathways and to jointly discuss candidates for biologics. Structured multidisciplinary boards may be helpful in clinical practice to discuss and quickly share information about candidates for biologics 23 , 43-45 .…”

Editorial: Dealing with asthma during the turbulent times of coronavirus disease-2019

“…Ramaswamy et al [5] report on the relationship of chronic rhinosinusitis (CRS) and severe asthma and their mutual interactions and reinforcements driving disease control and severity. Therefore, they advocate that management of patients with CRS and severe asthma should be conducted within a multidisciplinary setting including both otolaryngologists and pulmonologists.…”