Chronic rhinosinusitis with nasal polyps and asthma

Abstract

Individuals diagnosed with persistent rhinosinusitis with nasal polyps, characterized by a type 2 immunological signature, often experience severe and recurring symptoms. Asthma commonly coexists with this condition and shares similar underlying physiological mechanisms. Chronic rhinosinusitis with nasal polyps (CRSwNP) accompanied by asthma is marked by eosinophilic infiltration in the affected tissues and elevated levels of immunoglobulin E (IgE). Clinically, the presence of asthma in individuals with CRSwNP is linked to more severe sinonasal symptoms and a diminished quality of life. Managing this condition through medicinal and surgical interventions is more challenging due to the coexistence of asthma. This comorbidity is associated with higher susceptibility to exacerbations, increased airway obstruction, and more extensive eosinophilic inflammation. A subset of patients with CRSwNP also have aspirin-exacerbated respiratory disease (AERD), characterized by very severe and difficult-to-manage symptoms, and typically exhibit a high degree of nasal polyp severity. Understanding the shared pathophysiological pathways in both the upper and lower airways can greatly aid in the diagnosis and treatment of respiratory comorbidities. The systemic inflammatory link between chronic rhinosinusitis with nasal polyps and asthma underscores the need for systemic medications that specifically target common type 2 inflammatory mechanisms.