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. 2023 Jul 18;23(1):266.
doi: 10.1186/s12890-023-02556-8.

Comorbid asthma in patients with chronic rhinosinusitis with nasal polyps: did dupilumab make a difference?

Mona Al-Ahmad #  1   2 , Asmaa Ali #  3   4   5 , Mustafa Khalaf  3 , Abdulmohsen Alterki  6 , Tito Rodriguez-Bouza  7
Affiliations

Comorbid asthma in patients with chronic rhinosinusitis with nasal polyps: did dupilumab make a difference?

Mona Al-Ahmad et al. BMC Pulm Med. .

Abstract

Background: The clinical heterogeneity of chronic rhinosinusitis (CRS) and bronchial asthma is attributable to different underlying inflammatory profiles. However, the similarity between CRS with nasal polyps (CRSwNP) and type-2 asthma pathophysiology speculates that one biological therapy could affect both comorbidities. Despite dupilumab, a monoclonal antibody that targets IL-4α and IL-13 receptors, being used in patients with nasal polyps and severe asthma, real-life data about its efficacy in improving the quality of life and patient symptoms is still lacking. This study's primary objective was to evaluate dupilumab treatment's effect on the frequency of olfactory symptoms and health-related quality of life tests as measured by the Sino-nasal outcome test (SNOT-22) in patients with NP. The secondary objective was the effect of dupilumab on asthma symptom control as measured by the asthma control test (ACT).

Methods: A prospective study was conducted of 166 patients with CRSwNP, with or without asthma. The following variables were collected at baseline and after at least six months of continuous dupilumab therapy; SNOT-22, olfactory symptoms frequency, and ACT score.

Results: Asthma prevalence in patients with CRSwNP was high (59.63%), and being female with a history of frequent use of oral corticosteroid (OCS) courses and repeated unsuccessful nasal and para-nasal surgeries for polyposis increased the likelihood of having underlying asthma by 2, 1 and 4 times more, respectively. Additionally, being asthmatic required a longer duration of dupilumab treatment. However, both the health-related quality of life and olfactory symptoms improved equally in both groups.

Conclusion: Even with associated comorbid asthma in patients with CRSwNP, treatment with dupilumab could improve the quality of life, olfactory symptoms, and asthma symptom control.

Keywords: Asthma; Asthma control test; Chronic rhinosinusitis; Dupilumab; Nasal polyps; Sinonasal outcome test.

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Conflict of interest statement

All authors declare no conflict of interest. Each author has revised and approved the final version of the manuscript independently.

Figures

Fig. 1
Fig. 1
Recruitment for biological therapy
Fig. 2
Fig. 2
ROC curve of oral corticosteroid course number to discriminate asthma coexistence in patients with CRSwNP OCS-CN: oral corticosteroid course number, AUC: area under the curve, P < 0.05 considered significant: Receiver operating characteristic curve (ROC-curve) showed good utility of OCS-CN, AUC = 0.6, P = 0.02
Fig. 3
Fig. 3
Duration of Dupilumab in CRSwNP patients with and without asthma In non asthmatic patients the (mean ± SD) duration of dupilumab was (11.2 ± 4.1) month versus (13.8 ± 4.4) month in asthmatic group, the test of significant: Independent t-test, P < 0.05 considered significant
Fig. 4
Fig. 4
Asthma control test score after Dupilumab Test of significant: independent t-test, P < 0.05 considered significant
Fig. 5
Fig. 5
Impact of Dupilumab treatment on SNOT-22 score SNOT-22: Sino-Nasal outcome Test, Test of significant: independent t-test, P < 0.05 considered significant
Fig. 6
Fig. 6
Impact of Dupilumab on olfactory symptoms The test of significant: Chi square test, P < 0.05 considered significant
See this image and copyright information in PMC

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