Identification of severe eosinophilic asthma in patients with chronic rhinosinusitis and nasal polyps who are awaiting sinus surgery.

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common comorbidity within severe asthma populations; its presence is associated with increased severity of disease and eosinophilic inflammation that may require biologic therapies.

OBJECTIVE

We sought to identify potential patients with severe eosinophilic asthma in a population of patients with CRSwNP who were awaiting functional endoscopic sinus surgery (FESS) for nasal polyps.

METHODS

We conducted a service evaluation of patients with CRSwNP who were awaiting FESS in a district general hospital. We screened electronic records for eosinophil levels, previous asthma diagnosis, symptoms, and medical treatment.

RESULTS

Of the 709 patients on the otolaryngology waiting list, 123 patients with CRSwNP were awaiting FESS. Of those patients, 74 had previous eosinophilia (serum eosinophil count ≥ 0.3 x109/L), 32% were female, and their mean age was 53.5 years (SD 15 years). Of those 74 patients, 36 had a preexisting diagnosis of asthma, of whom 61% were at step 4 or 5 of the Global Initiative for Asthma guidelines, with 18% receiving 2 or more courses of oral steroids in the previous 12 months, 41% unknown to local asthma services, and 27% receiving biologic therapy for asthma. In addition, of those with eosinophilia with no previous asthma diagnosis who were awaiting FESS for nasal polyps (38 of 74), 26% had documented symptoms of breathlessness or wheeze.

CONCLUSION

We have identified patients with CRSwNP awaiting nasal polyp surgery who have eosinophillic asthma that may benefit from treatment optimization and review in a severe asthma service. Proactive identification of patients with severe asthma and comorbid CRSwNP who are currently awaiting FESS may widen access to asthma optimization and biologic medications.