Definition of severity and treatment response in chronic rhinosinusitis with nasal polyps: a Delphi study among French experts

ABSTRACT

Introduction

The introduction of biotherapies has significantly changed the management of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). These drugs are generally reserved for severe or recurrent CRSwNP. Thus, the concepts of severity of the disease and treatment response must be mastered by otorhinolaryngologists. However, a clear definition of these concepts in CRSwNP is missing.

Methods

This article focuses on definitions of severity and treatment response in CRSwNP by providing an expert consensus among French rhinologists, using a Delphi study.

Results

The severity assessment should seek the presence of uncontrolled asthma, olfactory disorders, nasal blockage, impaired quality of life (QOL) and cumulative annual dose of systemic corticosteroids.

The treatment response should assess the presence of olfactory disorders, nasal blockage, QOL impairment, response to background therapy, resistance and/or dependence to oral corticosteroids, cumulative annual dose of systemic corticosteroids, response to surgery and to biologics.

A failure after polypectomy should not be considered as a failure of surgical management of CRSwNP and must discuss the realization of an extended sinus surgery procedure before the prescription of biologics.

Conclusion

Definitions of severity, control of CRSwNP, as well as therapeutic strategies to improve patients’ QOL achieved high level of consensus.

KEYWORDS:

• CRSwNP
• nasal polyposis
• severity
• systemic corticosteroids
• treatment response

Acknowledgments

Authors want to acknowledge all French rhinologists experts from the “Association Française de Rhinologie” for their involvement in the Delphi process.

Declaration of interest

F Carsuzaa reports speaker fees, non-financial support and/other from GSK and Sanofi. L Fath reports speaker fees, non-financial support and/other from GSK and Sanofi. M Fieux reports speaker fees, non-financial support and/other from GSK and Sanofi. S Bartier reports speaker fees, non-financial support and/other from Sanofi. G de Bonnecaze reports speaker fees, non-financial support and/other from ALK-Abello, GSK, Medtronic, Sanofi-Aventis, and Zambon.

C Rumeau reports speaker fees, non-financial support and/other from ALK-Abello, GSK and Sanofi. J Michel reports speaker fees, non-financial support and/other from ALK-Abello, GSK, Medtronic, Novartis, Sanofi-Genzyme. JF Papon reports speaker fees, non-financial support and/other from ALK-Abello, Astra-Zeneca, GSK, Novartis and Sanofi-Genzyme. M Alexandru reports speaker fees, non-financial support and/other from ALK-Abello and Sanofi. V Favier reports speaker fees, non-financial support and/other from AstraZeneca, GSK, Sanofi and Stryker. 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

One peer reviewer has received honoraria from from Sanofi, GlaxoSmithKline and Novartis. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All authors made substantial contributions to the conception, acquisition, design of the work, or analysis of interpretation of data. All authors were responsible for important intellectual content, critically revising the work, and making all content and editorial decisions. All authors had final approval of the manuscript version to be published and are accountable for all aspects of the work in ensuring the accuracy and integrity of this manuscript.

Ethics

This study follows the principles of the Declaration of Helsinki. No IRB approval was required, as this study is an expert consensus without patient data.

Additional information

Funding

This paper was not funded.