Comorbid Chronic Rhinosinusitis and Asthma: Shared Risk Factors and Treatment Implications-An EAACI Task Force Report

Area of Science:

• Respiratory Medicine
• Immunology
• Otolaryngology

Background:

• Chronic rhinosinusitis (CRS) and asthma are common, frequently co-occurring conditions.
• Shared T-helper cell 2 (T2)-high inflammatory pathways, involving IL-4, IL-5, and IL-13, link these diseases.
• NSAID-exacerbated respiratory disease (N-ERD) is a severe phenotype combining CRS with nasal polyps (CRSwNP), asthma, and NSAID hypersensitivity.

Purpose of the Study:

• To explore shared risk factors for CRS and asthma comorbidity.
• To evaluate current and emerging therapeutic strategies for these conditions, particularly N-ERD.
• To identify research gaps and future directions for optimizing patient care.

Main Methods:

• Review of shared risk factors including genetics, epithelial barrier dysfunction, and microbiome dysbiosis.
• Evaluation of therapeutic strategies: biologics (dupilumab, mepolizumab, omalizumab, etc.), aspirin therapy after desensitization (ATAD), and endoscopic sinus surgery (ESS).
• Analysis of treatment effectiveness and challenges based on disease phenotypes and endotypes.

Main Results:

• Biologics demonstrate significant efficacy and safety in T2-high asthma and CRSwNP.
• ATAD offers a disease-modifying option for N-ERD, with adherence as a key challenge.
• ESS improves sinonasal and asthma outcomes, though repeat surgeries may be necessary.

Conclusions:

• Personalized treatment approaches are crucial due to variable outcomes based on individual phenotypes/endotypes.
• Further research is needed, including head-to-head trials comparing different therapies.
• Optimizing care requires refined treatment algorithms, biomarker identification, and long-term outcome assessment.