COVID-19 and chronic rhinosinusitis: management and comorbidity – what have we learned?

ABSTRACT

Introduction

Approximately 5%–12% of the population worldwide suffer from chronic rhinosinusitis (CRS). CRS is defined as a chronic respiratory disease and is considered to be a risk factor for COVID-19 patients.

Areas covered

A non-systematic literature research was conducted on COVID-19 and treatment options for CRSwNP. The latest international publications in medical databases, international guidelines, and the internet were reviewed. Since there were no publications on all aspects of this topic during the pandemic, we included our own experience in this report. Based on the conducted literature research in addition to our previously reported experience, we discuss the treatment of CRSwNP during the COVID-19 pandemic and what can be taken for future pandemics.

Expert opinion

Intranasal corticosteroids remain the standard treatment for CRS in patients with SARS-CoV-2 infection. Indications for surgical treatment of CRS should be critically evaluated and reserved for patients with complications and those with no other treatment options. For this purpose, COVID-19 status should be known if possible and, in case of unclear status (emergency), using appropriate personal protective equipment. Systemic corticosteroids should be avoided were possible. Biological treatment should be continued under careful monitoring in uninfected patients and should be temporarily interrupted during COVID-19 infection.

KEYWORDS:

• chronic rhinosinusitis
• COVID-19
• SARS-CoV-2
• nasal polyps
• CRSwNP
• biologics
• intranasal corticosteroids
• ACE2 receptor expression

Article highlights

• INCS do not increase the risk of infection or a severe course of COVID-19

• INCS should be taken consistently and regularly at the individually prescribed dose

• sGCS should be used with caution for CRS in the current COVID-19 pandemic

• corticosteroid inhalation therapy in comorbid asthma should be continued

• In COVID-19 patients biologics should be paused until the patient has recovered

Declaration of interest

We, the authors of this publication, hereby disclose our potential conflicts of interest in relation to the content presented in this work. Lead author: L. Klimek received research grants from Allergy Therapeutics/Bencard, GreatBritain/Germany; ALK-Abello,

Denmark; Allergopharma, Germany; ASITBiotech, Belgium; AstraZeneca, Sweden, Bionorica, Germany; Biomay, Austria, BoehringerIngelheim, Germany, Circassia, U.S.A.; Stallergenes, France; Cytos, Switzerland; Curalogic, Denmark; HAL, Netherlands, Hartington, Spain; Lofarma, Italy; Viatris/Mylan, U.S.A.; Novartis, Switzerland, Leti, Spain; ROXALL, Germany; GlaxoSmithKline (GSK), Great Britain; Sanofi, France and/or has served on the speaker’s bureau or was consulting for the above mentioned pharmaceutical companies. L Klimek is the current President of German Society of Allergology AeDA, Vice-President of the European Academy for Allergy and Clinical Immunology (EAACI). Vice-President of German Academy for Allergy and Environmental Medicine and Editor-in-Chief of Allergo Journal and Allergo Journal International. J. Hagemann received honoraria for talks from Sanofi, GSK, Novartis and Advisory Board honoraria by Sanofi and Novartis. T. Albrecht received honoraria for talks from Sanofi, GSK, Novartis and Advisory Board honoraria by Sanofi and Medtronic. S. Becker received honoraria for talks and consultation from ALK Abéllo, Allergopharma, BencardAllergy, Allergy Therapeutics, HAL Allergy, Thermo Fisher Scientific, Sanofi Genzyme, MSD, AstraZeneca, GSK, Novartis, Stryker and Ambu. T. Huppertz, F. Bärhold, F. Klimek, I. Casper, M. Cuevas and C. Bergmann have nothing to disclose. 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

Additional information

Funding

This paper was not funded.