Nasal polyposis and asthma: The otorhinolaryngologist’s view

Asthma patients, especially those with severe asthma, often have CRS with nasal polyps (CRSwNP). In particular, patients with late-onset asthma, high periostin levels and eosinophilia often have CRSwNP. Insufficient control of the upper airways results in insufficient control of asthma and vice versa. In severe uncontrolled asthma in particular, the upper airways are often difficult to control. For this reason, it is important that people treating the lower airways, especially for severe asthma, are also experts on the upper airways. CRS has a significant impact on the QoL of the patient, comparable to congestive heart failure and COPD. The pathophysiology of CRS is complex, and includes local, systemic, microbial, environmental, genetic and iatrogenic factors. Severe CRSwNP, mostly with asthma, especially in Europe and the USA, has a type 2 inflammation with IgE, eosinophils and Th2 cytokines, such as IL-5 and IL-4/IL-13. The development of biological therapies has progressed rapidly in recent years and they have been shown to be effective in CRSwNP, as in asthma. Endoscopic sinus surgery has been shown to improve the lower airways and reduce medication use for asthma, and may even prevent asthma from developing.