Q&A: Comorbid chronic rhinosinusitis with nasal polyps, asthma require better management
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As the prevalence of chronic rhinosinusitis with nasal polyps grew in Finland between 2012 and 2019, asthma increased the need for corticosteroids and surgery as well, according to a study published in Clinical and Translational Allergy.
This study, which involved 53,119 adults with CRSwNP including 18,563 incident patients, led the researchers to determine that patients with comorbid asthma need to improve the management of their CRSwNP.
Healio spoke with 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, to find out more.
Healio: What prompted this study?
Toppila-Salmi: Chronic rhinosinusitis is one of the most common chronic adult health problems in the Western world, affecting approximately every tenth person. CRSwNP affects a large part of the population, roughly 1:100 of the general population and 1:4 of patients with chronic rhinosinusitis.
But these numbers are merely estimates, as there is some lack of prevalence data across many geographic areas. The nasal polyps prevalence estimates in the Nordic countries range from 2.7% to 4.3%, based on a small number of municipality studies that are 2 decades old.
Therefore, an update in incidence and prevalence on a national level was sought. Thus, we ventured to fill the data gaps, and the register data utilized in our recent study allowed for a solid analysis of nationwide health care data with excellent data coverage.
According to the united airway theory, upper and lower airway disease are directly related, with a similar inflammatory profile. Studies suggest that asthma is strongly associated with CRSwNP, with roughly half of the patients with CRSwNP having or developing asthma. Here, we wanted to study the numbers in the real world, covering both primary and specialty care patients.
CRSwNP is usually managed with nasal or oral corticosteroids. For patients who do not respond to conservative therapy, endoscopic sinus surgery (ESS) is considered. Yet, in patients with uncontrolled airway disease, ESS is not sufficient for disease management, but revision ESS and medication will be required. Therefore, the real-world disease burden of patients with CRSwNP and comorbid asthma required further elucidation to improve management of the disease.
Healio: Were there any particularly surprising or significant results you would like to spotlight?
Toppila-Salmi: The prevalence of CRSwNP increased between the years 2012 and 2019 from about 6% to 8.6%, likely due to the aging population, which calls for more effective disease management.
Based on real-world data, we found that 27% of patients with CRSwNP have comorbid asthma. Our current data, however, uniquely spans all patients in both primary and specialty care, nationwide, which shows the full spectrum from mild to severe cases.
In patients with CRSwNP and comorbid asthma, and especially in patients with severe asthma, the use of systemic corticosteroids increased as well as the likelihood of requiring repeated ESS.
Healio: How can doctors use these findings to improve care?
Toppila-Salmi: As the prevalence rises, management needs to be improved. As it is recognized that CRSwNP and asthma are part of the same disease spectrum, targeted therapies treating both the upper and lower airway disease, preferably as a single therapy, should actively be considered. This could optimally lead to a reduced utilization of systemic corticosteroids, which carry a significant risk for long-term side effects, and may also lead to a reduced need for surgical procedures.
Overall, the study highlights that it is important to pay attention to comorbidities like asthma among patients with CRSwNP because the comorbidities increase disease burden and health care utilization. Therefore, multidisciplinary care and close collaboration between different specialties is critical for optimal management of these patients with concomitant CRSwNP and asthma.
Healio: What is the next step in this research?
Toppila-Salmi: The next step is to assess the health care utilization costs for patients with CRSwNP and asthma, as it is known that CRSwNP is affecting the working age population, generating significant costs.
For more information:
Sanna Toppila-Salmi, MD, PhD, can be reached at sanna.salmi@helsinki.fi.