An update on the role of chronic rhinosinusitis with nasal polyps as a co-morbidity in severe asthma

ABSTRACT

Introduction

Chronic rhinosinusitis and asthma are heterogeneous diseases with complex pathogenesis. The presence of chronic rhinosinusitis with nasal polyps has been associated with increased asthma exacerbation frequency and may represent a predictor of future exacerbations in severe asthma.

Areas covered

This review provides the clinician with an overview of the prevalence and clinical impact of the chronic rhinosinusitis with nasal polyps in severe asthma and summarizes recommended therapeutic approaches, including innovative biologic therapies. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed and ClinicalTrials.gov databases, using terms ‘chronic rhinosinusitis with nasal polyps’ AND ‘asthma’ OR ‘severe asthma.’ The literature review was performed for publication years 2010–2020, restricting the articles to humans and English language publications.

Expert opinion

Biological therapies have opened new perspectives in the treatment of upper and lower airway allergic diseases. Care pathways in severe asthma are almost consolidated, while they still rely on phenotypic rather than endotypic features in chronic rhinosinusitis with nasal polyps. Unveiling the correlation between clinical phenotypes and molecular endotypes will allow better stratification of patients with chronic rhinosinusitis with nasal polyps to identify candidates who benefit most from biological therapy.

KEYWORDS:

• Asthma
• biologics
• chronic rhinosinusitis with nasal polyps

Article highlights

• Chronic rhinosinusitis is one of the most frequent comorbidities contributing to an increased overall disease burden among patients with asthma.

• In the context of united airways disease, chronic rhinosinusitis with nasal polyps and asthma share common pathophysiological mechanisms, mainly sustained by type 2 cytokines.

• Biological therapies targeting type 2 inflammation represent the most innovative therapies for both severe asthma and uncontrolled chronic rhinosinusitis with nasal polyps and need to be implemented in the care pathways of chronic respiratory diseases.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.