Care for Patients with Type-2 Chronic Rhinosinusitis

Abstract

In the last 20 years, growing interest in chronic rhinosinusitis (CRS) has become evident in medical literature; nevertheless, it is still difficult to identify the real prevalence of the disease. Epidemiological studies are few and focused on heterogeneous populations and diagnostic methods. Recent research has contributed to identifying CRS as a disease characterized by heterogeneous clinical scenarios, high impact on quality of life, and elevated social costs. Patient stratification with phenotypes and identification of the pathobiological mechanism at the origin of the disease (endotype) and its comorbidities are pivotal in the diagnostic process, and they should be addressed in order to properly tailor treatment. A multidisciplinary approach, shared diagnostic and therapeutic data, and follow-up processes are therefore necessary. Oncological multidisciplinary boards offer models to imitate in accordance with the principles of precision medicine: tracing a diagnostic pathway with the purpose of identifying the patient's immunological profile, monitoring therapeutical processes, abstaining from having only a single specialist involved in treatment, and placing the patient at the center of the therapeutic plan. Awareness and participation from the patient's perspective are fundamental steps to optimize the clinical course, improve quality of life, and reduce the socioeconomic burden.

Keywords: chronic rhinosinusitis; monoclonal antibodies; nasal polyps; personalized medicine; sinus surgery; type-2 inflammation.

Figure 1

Multidisciplinary approach to patients with chronic rhinosinusitis.

Figure 2

Genetic, environmental, and behavioral factors contribute, together with comorbidities, to determine the degree of upper airway type-2 inflammation, with consequences for clinical expression and severity (e.g., recurrence after surgical treatment) of chronic rhinosinusitis. (A) Post-nasal drip, as an example of pure upper airway inflammatory involvement; (B) Chronic rhinosinusitis with nasal polyps, a more structured inflammatory condition; (C) CT-scan with extended chronic rhinosinusitis with concomitant bone remodeling as a consequence of chronic inflammation.