ABSTRACT
Introduction
Chronic rhinosinusitis (CRS) is a heterogeneous disease, and its complex pathophysiological characteristics pose a challenge to its clinical treatment. CRS is distinguished not only by clinical phenotype but also by endotype characteristics, which are divided into type 2 CRS and non-type 2 CRS.
Areas covered
In this review, we summarize and discuss current studies that depict the mechanisms and endotypes of CRS. In particular, inflammatory cells and the microbiome play a role in the pathophysiology of CRS. We also listed some of the biomarkers described in recent studies that may serve as a theoretical foundation for additional investigations. We have summarized the advantages and disadvantages of existing treatments and listed the available biological treatments for CRS in detail.
Expert opinion
Endotype-driven therapeutic options face many challenges because of the complexity of the disease. Glucocorticoids, nasal endoscopic surgery, and biological therapy are the main treatments used in clinical practice, but they have limitations. This review provides advice on the clinical management and treatment options for patients with different endotypes, which will be more conducive to improving the quality of life and reducing the financial burden on patients.
Article highlights
Different endotypes (type 1, type 2, and type 3) are the key to studying CRS.
The investigation of CRS endotypes covers the mechanisms of inflammatory cells, typical biomarkers, and the microbiome.
Clinicians need to choose the appropriate treatments based on the patient’s endotype characteristics.
Although there have been tremendous advancements in biological therapy for the treatment of CRSwNP, multidisciplinary decision-making is still necessary to choose which antibody type to use (anti-IgE, anti-IL-4/13 receptor, or anti-IL-5/IL-5 receptor).
The application of these study findings to clinical treatment should be the focus of future investigations.
Declaration of interest
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.