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Chronic Rhinosinusitis with Nasal Polyps and Asthma
Tanya M Laidlaw1, Joaquim Mullol2, Katharine M Woessner3
1Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
The Journal of Allergy and Clinical Immunology. in Practice
|October 16, 2020
Summary
Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma share type 2 inflammation. Systemic biologic therapies targeting these pathways offer new treatment options for severe, difficult-to-manage respiratory conditions.
Area of Science:
- Immunology
- Otolaryngology
- Pulmonology
Background:
- Chronic rhinosinusitis with nasal polyps (CRSwNP) often involves a type 2 immune signature, leading to severe and recurrent disease.
- Asthma frequently co-occurs with CRSwNP, sharing similar underlying pathophysiology, tissue eosinophilia, and elevated local IgE levels.
- The comorbidity of CRSwNP and asthma results in more severe sinonasal symptoms, reduced quality of life, and treatment resistance in both conditions.
Purpose of the Study:
- To highlight the shared type 2 inflammatory pathways in CRSwNP and comorbid asthma.
- To emphasize the clinical challenges and severity associated with CRSwNP in patients with asthma, including Aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (AERD).
- To advocate for a unified approach to managing upper and lower airway diseases by targeting common inflammatory mechanisms.
Main Methods:
- Review of existing literature on CRSwNP, asthma, and their shared inflammatory pathways.
- Analysis of clinical characteristics and treatment challenges in patients with comorbid CRSwNP and asthma.
- Exploration of the rationale for systemic biologic therapies targeting type 2 inflammation.
Main Results:
- CRSwNP with asthma exhibits significant tissue eosinophilia and high local IgE, contributing to disease severity.
- Aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (AERD) represents a severe phenotype of CRSwNP with asthma, characterized by difficult-to-treat polyps and inflammation.
- The interconnected pathophysiology necessitates a systemic treatment approach, moving beyond isolated management of nasal and lung conditions.
Conclusions:
- The shared type 2 inflammation in CRSwNP and asthma underscores the need for integrated management strategies.
- Systemic biologic treatments targeting shared type 2 inflammatory pathways present a promising therapeutic avenue for severe CRSwNP with comorbid asthma.
- Recognizing the systemic link between upper and lower airway inflammation is crucial for improving patient outcomes.
Keywords:
Aspirin/NSAID-exacerbated respiratory diseaseAsthmaChronic rhinosinusitis with nasal polypsType 2 inflammationMore Related Videos
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