Asthma associated with greater treatment in chronic rhinosinusitis with nasal polyps

Asthma associated with greater treatment in chronic rhinosinusitis with nasal polyps

04 November 2022

2 minutes of reading


Disclosures: Toppila-Salmi reports receiving a grant from GSK and consulting for ALK Abello, AstraZeneca, ERT, Novartis, Sanofi Pharma, and Roche. Please refer to the study for relevant financial disclosures of all other authors.


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According to a study published in Clinical and Translational Allergy.

These results indicate the need to improve the management of CRSwNP among patients with comorbid asthma, fury topila-Small game stew, MD, PhD, senior consultant otolaryngologist in the departments of allergology and pulmonary medicine, Heart and Lung Center, Skin and Allergy Hospital, Helsinki University Hospital, and colleagues.



Systemic corticosteroid use among patients with CRSwNP includes 54.1% of patients without asthma, 94.9% of those with severe controlled asthma, and 99.3% of those with severe uncontrolled asthma .
Data were derived from Toppila-Salmi S, et al. clin Translate Allergy. 2022;doi:10.1002/clt2.12200.

The study involved 53,119 adults diagnosed with CRSwNP between January 1, 2012, and December 31, 2018, including 18,563 incident patients (59.9% male; median age at diagnosis, 53 years; range interquartile, 39-65).

The lifetime prevalence of CRSwNP increased from 602.2 patients per 100,000 population in 2012 to 856.7 per 100,000 in 2019 (P < 0.001), although the incidence fell from 50.5 patients to 43.4 per 100,000 during that period (P = .004).

Also, 27% of incident patients had a diagnosis of asthmaincluding 5.8% with severe asthma and 1.5% with severe uncontrolled asthma.

Furthermore, 62.7% of the patients had used systemic corticosteroids (SCS) during the study period, including 54.1% of patients without asthma, 94.9% of patients with severe controlled asthma, and 99.3% of patients with severe uncontrolled asthma (P < .001).

Uncontrolled severe CRSwNP was more common among patients who had comorbid asthma (P < 0.001), with proportions ranging from 2.4% of patients without asthma to 16.3% of patients with severe uncontrolled asthma.

Asthma status and severity influenced the mean cumulative count of endoscopic sinus surgeries (ESS), the researchers found.

The mean ESS count within 3 years of diagnosis increased from 0.49 among patients without asthma to 0.68 among patients with severe controlled asthma and 0.8 among patients with severe uncontrolled asthma.

Overall, 46.7% of patients with incident CRSwNP had an ESS to treat their polyps, with a 40.6% (95% CI, 39.9%-41.3%) chance of ESS at the within 1 year of diagnosis.

The median time from diagnosis to first ESS was shorter among patients with CRSwNP and severe uncontrolled asthma versus mild to moderate asthma (11 months versus 20 months).

Among the patients who had ESS, 16.6% had two or more.

Asthma comorbidity increased the likelihood of another surgery, the researchers continued, with more severe asthma leading to earlier surgery.

The odds of additional ESS within 2 years of a first procedure included 9.5% (95% CI, 8.7%-10.2%) for patients without asthma, 12.6% (95% CI, 11, 2%-14%) for those with mild to moderate asthma. asthma, 13.5% (95% CI, 10.3%-16.7%) for patients with severe controlled asthma and 17.9% (95% CI, 11.9%-23.5%) among patients with severe uncontrolled asthma.

The researchers also found that asthma was the only disease associated with uncontrolled severe CRSwNP (P < 0.001), including adjusted odds ratios of 4.04 (95% CI, 3.44-4.75) for non-severe asthma, 7.01 (95% CI, 5.5-8.93) for asthma severe and 8.82 (95% CI, 6.25-12.43) for severe uncontrolled asthma.

Considering increases in the prevalence of CRSwNP and its subsequent surgical and corticosteroid treatment, especially among patients with asthma, the researchers called for special attention to these patients and new treatment modalities to address airway inflammation. to improve the burden of disease.

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