Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma

José Antonio Castillo; Vicente Plaza; Gustavo Rodrigo; Berta Juliá; César Picado; Cristina Fernández; Joaquim Mullol

doi:10.1016/j.jacig.2023.100134

Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma

J Allergy Clin Immunol Glob. 2023 Jul 3;2(4):100134. doi: 10.1016/j.jacig.2023.100134. eCollection 2023 Nov.

Authors

José Antonio Castillo^{1

2

3}, Vicente Plaza⁴, Gustavo Rodrigo⁵, Berta Juliá⁶, César Picado^{2

7}, Cristina Fernández⁸, Joaquim Mullol^{2

3

9}

Affiliations

¹ Pneumology Department, Hospital Universitari Dexeus, Barcelona, Spain.
² CIBER of Respiratory Diseases, Spain.
³ Group of Rhinitis, Rhinosinusitis, and Nasal Polyps, Area of Asthma, SEPAR, Spain.
⁴ Pneumology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
⁵ Emergency Departament, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
⁶ Medical Department, MSD Madrid, Spain.
⁷ Pneumology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
⁸ Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Fundación IMAS, Santiago de Compostela, Spain.
⁹ Clinical and Experimental Respiratory Immunoallergy, IDIBAPS & Rhinology Unite and Smell Clinic, ENT Department, Hospital Clínic Barcelona, Universitat de Barcelona, Spain.

Abstract

Background: Respiratory multimorbidities are linked to asthma, such as allergic rhinitis (AR) with early allergic asthma and chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) with late nonallergic asthma.

Objective: Our aim was to investigate the association of asthma severity and control with specific upper airway phenotypes.

Method: Patients with asthma were prospectively recruited from 23 pulmonology and ear, nose, and throat clinics. Asthma severity and control, as well as upper airway comorbidities (AR and non-AR [NAR], CRSwNP, and CRS without nasal polyps [CRSsNP]) were assessed according to international consensus guidelines definitions.

Results: A total of 492 asthmatic patients were included. Half of the asthmatic patients (49.6%) had associated rhinitis (37.0% had AR and 12.6% had NAR) and 36.2% had CRS (16.7% had CRSsNP and 19.5% had CRSwNP), whereas 14.2% had no sinonasal symptoms. Most cases of AR (78%) and NAR (84%) were present in patients with mild-to-moderate asthma, whereas CRSwNP was more frequent in patients with severe asthma (35% [P < .001]), mainly nonatopic asthma (44% [P < .001]). Patients with severe asthma with CRSwNP had worse asthma control, which was correlated (r = 0.249 [P = .034]) with sinus occupancy. Multiple logistic regression analysis showed that late-onset asthma, intolerance of aspirin and/or nonsteroidal anti-inflammatory drugs, and CRSwNP were independently associated with severe asthma.

Conclusion: Severe asthma is associated with CRSwNP, with sinus occupancy affecting asthma control. This study has identified 2 main different upper airway treatable traits, AR and CRSwNP, which need further evaluation to improve management and control of patients with asthma.

Keywords: Asthma; allergic rhinitis; asthma control; asthma severity; chronic rhinosinusitis with nasal polyps; united airway disease.