Patients with chronic
rhinosinusitis with
nasal polyps (CRSwNP) characterized by a type 2 immune signature often have severe and recurrent disease. Lower airway conditions such as
asthma are common comorbidities and share similar pathophysiology. CRSwNP with
asthma is characterized by tissue
eosinophilia and high local
IgE levels. Clinically, CRSwNP with comorbid
asthma is associated with more severe sinonasal symptoms and worse quality of life, and it is more difficult to treat both medically and surgically.
Asthma in the presence of nasal polyposis is also more difficult to control, being more exacerbation prone, with increased
airway obstruction and more extensive eosinophilic
inflammation.
Aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (AERD) is a recognized phenotype of CRSwNP with comorbid
asthma. Patients with CRSwNP with comorbid AERD are among those with the most severe and difficult-to-treat disease, and tend to have severe NP. The shared pathophysiology of the upper and lower airways has important implications for both the diagnosis and management of respiratory comorbidities. However, in clinical practice, the nose and lungs are often treated as separate entities. The underlying systemic inflammatory link between CRSwNP and
asthma provides a compelling rationale for systemic treatment with novel biologics targeting shared underlying type 2 inflammatory pathways.