4.4 Review

Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations

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Factors Associated with Revision Sinus Surgery in Patients with Chronic Rhinosinusitis

Karina Bayer et al.

Summary: This study aimed to assess which factors and phenotypes of CRS are associated with revision surgery in patients undergoing ESS. Based on a retrospective analysis, age, gender, AERD, asthma, and allergies were found to be associated with higher odds of revision surgery.

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Long-term evaluation of nasal polyposis recurrence: A focus on multiple relapses and nasal cytology

Giuseppe Riva et al.

Summary: The study found that CRSwNP has a high risk of recurrence, even more than 10 years after surgery. Nasal cytology can identify individuals with a higher risk of early recurrence.

AMERICAN JOURNAL OF OTOLARYNGOLOGY (2022)

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Prognostic factors for polyp recurrence in chronic rhinosinusitis with nasal polyps

Junqin Bai et al.

Summary: This study aimed to evaluate the impact of polyp recurrence (PR) on disease severity post-ESS and quantify the prognostic value of various clinical variables and biomarkers. The study found a significant association between PR and radiographic and sinonasal test scores post-ESS. A combined model incorporating clinical and biomarker factors accurately predicted PR.

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Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial

Claus Bachert et al.

Summary: This study assessed the efficacy and safety of benralizumab in treating CRSwNP. The results showed that benralizumab significantly improved NPS and nasal blockage score, and had significant improvement on difficulty with sense of smell score. Subgroup analyses suggested influences of comorbid asthma, number of NP surgeries, sex, body mass index, and baseline blood eosinophil count on treatment effects.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2022)

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Impact of sinus surgery on type 2 airway and systemic inflammation in asthma

Kazuki Hamada et al.

Summary: This study evaluated the relationship between asthma control and airway/systemic inflammation in eosinophilic CRSwNP patients with not well controlled asthma who underwent ESS, and found that sinus surgery impacts asthma control through the suppression of airway/systemic type 2 inflammation in these patients. The study reinforced the common pathophysiology of type 2 inflammation between the upper and lower airways.

JOURNAL OF ASTHMA (2021)

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Cost Utility Analysis of Dupilumab Versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps

George A. Scangas et al.

Summary: The study compared the cost-effectiveness of dupilumab and ESS in treating CRSwNP, with the results showing that the ESS treatment strategy is more cost-effective. Further research is needed to identify potential phenotypes or endotypes that will benefit most from dupilumab treatment in a cost-effective manner.

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Surgery in Nasal Polyp Patients: Outcome After a Minimum Observation of 10 Years

Stephan Vlaminck et al.

Summary: Recurrence after CRSwNP surgery is common, with a rate of 62%, and is significantly associated with local eosinophilia and ERM. Asthma is a common comorbid factor, developing even at higher age despite surgical treatment for CRSwNP, and is also associated with a higher recurrence rate. Sustained medical care after surgery is mandatory.

AMERICAN JOURNAL OF RHINOLOGY & ALLERGY (2021)

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Should Oral Corticosteroids be Used in Medical Therapy for Chronic Rhinosinusitis? A Risk Analysis

Randy M. Leung et al.

Summary: The effectiveness of oral corticosteroids in the treatment of chronic rhinosinusitis remains controversial. This study aimed to determine the threshold effectiveness of oral corticosteroids in averting endoscopic sinus surgery. Results showed a minimum effectiveness of 20.8% for chronic sinusitis without nasal polyps and 16.8% for chronic sinusitis with nasal polyps.

LARYNGOSCOPE (2021)

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Impact of asthma on endoscopic sinus surgery outcomes for chronic rhinosinusitis with polyposis - A cohort study

Meryem Lahjaouj et al.

Summary: This study aimed to evaluate the prevalence and severity of CRS clinical manifestations and explore the potential relationship between symptom scores, asthma, and surgical outcomes. The results showed a more significant improvement in symptoms after surgery for asthma patients, but asthma did not significantly impact the quality of life in the CRSwNP population.

ANNALS OF MEDICINE AND SURGERY (2021)

Article Allergy

Chronic Rhinosinusitis with Nasal Polyps and Asthma

Tanya M. Laidlaw et al.

Summary: Patients with CRSwNP and asthma often have severe and recurrent disease with tissue eosinophilia and high IgE levels. The shared pathophysiology between upper and lower airways highlights the importance of systemic treatment targeting type 2 inflammatory pathways.

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Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence

Xiaoyan Wang et al.

Summary: This study found that combining asthma history and blood eosinophils percentage can predict the recurrence of chronic rhinosinusitis with nasal polyps. Asthma history can reduce the threshold of blood eosinophils percentage for predicting recurrence.

ACTA OTO-LARYNGOLOGICA (2021)

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EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: Definitions and management

Claus Bachert et al.

Summary: Uncontrolled severe CRSwNP can be challenging due to its association with asthma, NSAID-exacerbated respiratory disease, and allergies. The European Forum proposes structured definitions to facilitate communication among clinicians and offers a practical algorithm for defining type 2 inflammation in CRSwNP. Suggestions for evaluating treatment options, including surgery and biologics, are provided to inform patients for decision-making processes.

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY (2021)

Review Otorhinolaryngology

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Richard R. Orlandi et al.

Summary: The executive summary of ICAR-RS-2021 compiles evidence-based recommendations for medical and surgical treatment of rhinologic diseases, covering both medical and surgical management with a comprehensive management algorithm.

INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY (2021)

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Onset of effect and impact on health-related quality of life, exacerbation rate, lung function, and nasal polyposis symptoms for patients with severe eosinophilic asthma treated with benralizumab (ANDHI): a randomised, controlled, phase 3b trial

Tim W. Harrison et al.

Summary: The study aimed to evaluate the efficacy of benralizumab in severe eosinophilic asthma patients, including onset of effect, impact on health-related quality of life, exacerbation rate, lung function, and nasal polyposis symptoms. Results showed that benralizumab significantly reduced exacerbation risk and improved HRQOL, lung function, and nasal symptoms early in the treatment period compared to placebo.

LANCET RESPIRATORY MEDICINE (2021)

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Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines

Ioana Agache et al.

Summary: This systematic review found that Dupilumab, Omalizumab, and Mepolizumab have some evidence supporting their efficacy and safety for patients with CRSwNP, reducing the need for surgery or oral corticosteroid use, and improving smell and quality of life.

ALLERGY (2021)

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Asthma increases long-term revision rates of endoscopic sinus surgery in chronic rhinosinusitis with and without nasal polyposis

Amarbir S. Gill et al.

Summary: This study found that the revision rate of ESS in CRS-A patients was twice that of CRS-alone, and patients with a history of allergies, asthma, and nasal polyps were more likely to require revision ESS.

INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY (2021)

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Benefits of biologic therapy administered for asthma on co-existent chronic rhinosinusitis: A real-world study

Shilpika Bajpai et al.

Summary: This study evaluated the effects of biologic therapy for asthma on co-existent CRS and found that anti-IL-5 agents improved CT and SNOT-22 scores in the overall CRS group and CRSwNP subgroup. Omalizumab improved CT scores but not SNOT-22 scores, with 22% of patients undergoing ESS after initiating biologics. These real-world results may impact future trial designs and clinical applications of biologics for CRS.

INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY (2021)

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Indirect Treatment Comparison of Biologics in Chronic Rhinosinusitis with Nasal Polyps

Anju T. Peters et al.

Summary: In this study, an indirect treatment comparison (ITC) was conducted to compare the efficacy of biologics plus INCS versus placebo among patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Results indicated that at week 24, dupilumab showed significantly greater improvements in key CRSwNP outcomes compared to omalizumab.

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Impact of type 2 targeting biologics on acute exacerbations of chronic rhinosinusitis

Gayatri B. Patel et al.

Summary: The study showed that type 2-targeting biologics significantly reduced medication use for AECRS, especially in patients with a history of frequent antibiotic treatment.

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Characteristics of patients with severe asthma who experienced treatment failure with omalizumab

Tomohiro Akaba et al.

Summary: This study found that patients with eosinophilic sinusitis and eosinophilic otitis media were more likely to have treatment failure with omalizumab. Multivariate analysis showed that eosinophilic chronic rhinosinusitis and eosinophilic otitis media were associated with failure of omalizumab treatment. Most patients in the omalizumab-ineffective group with eosinophilic comorbidities of the ear, nose, and throat received mepolizumab or benralizumab as alternative therapy, leading to disease control.

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Cost-effectiveness analysis comparing dupilumab and aspirin desensitization therapy for chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease

Michael Yong et al.

Summary: The study compared the cost-effectiveness of ASA desensitization with dupilumab therapy in treating CRSwNP in AERD patients. It found that ASA desensitization after surgery was cost-effective, while upfront dupilumab therapy was not. Adding salvage dupilumab was also cost-effective, indicating that it could be a beneficial treatment option for severe CRSwNP patients.

INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY (2021)

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Benralizumab Effectiveness in Severe Eosinophilic Asthma with and without Chronic Rhinosinusitis with Nasal Polyps: A Real-World Multicenter Study

Santi Nolasco et al.

Summary: Real-world data suggests that benralizumab is a valid add-on therapeutic option for patients with severe eosinophilic asthma, especially those with comorbid chronic rhinosinusitis with nasal polyps. Treatment with benralizumab led to significant improvements in asthma exacerbations, lung function, and blood cell counts, indicating its potential efficacy in managing late-onset severe asthma.

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Mepolizumab improves sino-nasal symptoms and asthma control in severe eosinophilic asthma patients with chronic rhinosinusitis and nasal polyps: a 12-month real-life study

Aikaterini Detoraki et al.

Summary: In this study, mepolizumab treatment for 1 year in 44 severe eosinophilic asthma patients with CRSwNP showed significant improvements in sino-nasal symptoms, asthma symptoms, and a reduction in polyp growth.

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