Comparison the Impacts of Asthma and Allergic Rhinitis on Chronic Rhinosinusitis With Nasal Polyps

Asthma (AS) and allergic rhinitis (AR) are the two most common comorbidities for chronic rhinosinusitis with nasal polyps (NP). This study aims to compare the different impacts of AS and AR on NP, including disease severity, inflammatory profiles, and surgical outcomes.

The retrospective study enrolled NP patients who underwent endoscopic sinus surgery and 12 months follow-up. They were categorized into four groups based on the presence of AS and/or AR: NP with AS and AR (NP + AS+AR); NP with AS only (NP + AS); NP with AR only (NP + AR); NP without AS and AR (NP-alone). Preoperative and postoperative measures included Lund-Mackay (LM) score, TNSS, VAS, SNOT-22, and postoperative endoscopic score (E-score). Blood and tissue eosinophil (Eos) conditions and protein levels of inflammatory cytokines in NP tissue were measured.

A total of 185 NP patients were included. Compared to NP-alone patients, NP + AS + AR and NP + AS had higher uncontrolled rates (p < 0.05). At baseline, NP + AS had higher SNOT-22, VAS of olfactory, LM scores, blood and tissue Eos count, and proportion of ECRS than NP-alone (p < 0.05). After surgery, NP + AS still had higher SNOT-22 and worse E-score than NP-alone (p < 0.05). In contrast, the NP + AR group only had worse VAS of olfactory than NP-alone before surgery (p < 0.05), but did not differ from NP-alone in other aspects mentioned above. After Multivariate Logistic regression analysis, AS was the risk factor for CRS uncontrol status and ECRS (p < 0.05).

The uncontrolled status in NP patients is significantly affected by comorbid AS but not AR. Both AS and AR may also affect NP disease severity and the degree of eosinophilic inflammation, while the former may be significantly serious.