Asthma associated with increased treatment in chronic rhinosinusitis with nasal polyps

The prevalence of chronic rhinosinusitis with nasal polyps grew in Finland from 2012 to 2019, with asthma increasing patients’ need for corticosteroids and surgery, according to a study published in Clinical and Translational Allergy.

These results indicate a need to improve CRSwNP management among patients with comorbid asthma, Sanna Toppila-Salmi, MD, PhD, senior consultant otorhinolaryngologist in the departments of allergology and pulmonary medicine, Heart and Lung Center, Skin and Allergy Hospital, Helsinki University Hospital, and colleagues wrote.

The study involved 53,119 adults diagnosed with CRSwNP between Jan. 1, 2012, and Dec. 31, 2018, including 18,563 incident patients (59.9% men; median age at diagnosis, 53 years; interquartile range, 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 < .001), although incidence fell from 50.5 patients to 43.4 per 100,000 during that period (P = .004).

Also, 27% of the incident patients had an asthma diagnosis, including 5.8% with severe asthma and 1.5% with severe uncontrolled asthma.

Further, 62.7% of patients had used systemic corticosteroids (SCS) during the study period, including 54.1% of the patients who did not have asthma, 94.9% of the patients with severe controlled asthma and 99.3% of the patients with severe uncontrolled asthma (P < .001).

Severe uncontrolled CRSwNP was more common among patients who had comorbid asthma (P < .001), with proportions ranging from 2.4% of the patients with no asthma to 16.3% of the patients with severe uncontrolled asthma.

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

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

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

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

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

Probabilities for additional ESS within 2 years of a first procedure included 9.5% (95% CI, 8.7%-10.2%) for patients with no asthma, 12.6% (95% CI, 11.2%-14%) for those with mild to moderate 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 severe uncontrolled CRSwNP (P < .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 severe asthma and 8.82 (95% CI, 6.25-12.43) for severe uncontrolled asthma.

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