Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

Eugenio De Corso¹, Adriano Vaghi², Marco Corbò¹, Carlotta Pipolo³, Alessandra Vultaggio⁴, Andrea Matucci⁴, Elena Cantone⁵, Gianenrico Senna⁶, Marco Caminati⁶, Frank Rikki Canevari⁷, Carlo Lombardi⁸, Aikaterini Detoraki⁹, Giorgio Walter Canonica¹⁰, Jan Walter Schroeder¹¹, Maria D'Amato¹², Maria Angiola Crivellaro¹³, Matteo Gelardi¹⁴, Francesco Antonio Salzano¹⁵, Davide Mattavelli¹⁶, Vittorio Rampinelli¹⁶, Alberto Macchi¹⁷, Ernesto Pasquini¹⁸, Manuele Casale¹⁹, Stefania Gallo¹⁷, Girolamo Pelaia²⁰, Claudia Crimi²¹, Giovanna Elisiana Carpagnano²², Enrico Heffler²³, Eustachio Nettis²⁴, Maria Beatrice Bilò²⁵, Veronica Seccia²⁶, Giancarlo Ottaviano²⁷, Claudio Micheletto²⁸, Stefano Del Giacco²⁹, Cristiano Caruso³⁰, Diego Bagnasco³¹, Matteo Bonini³², Francesco Menzella³³, Giulio Cesare Passali³⁴, Giandomenico Maggiore³⁵, Fabiano Di Marco³⁶, Francesco Maria Passali³⁷, Loreta Di Michele³⁸, Giampietro Ricci³⁹, Jacopo Galli¹, Fabio Pagella^{40

41}

Affiliations

¹ Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli Hospital IRCCS, Rome, Italy.
² Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASST Rhodense, Garbagnate Milanese (MI), Italy.
³ Otorhinolaryngology Unit, Head and Neck Department, ASST Santi Paolo e Carlo Hospital, Milan, Italy.
⁴ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
⁵ Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, Naples, Italy.
⁶ Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy.
⁷ Department 1 DISC, Otorhinolaryngology Unit, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy.
⁸ Departmental Unit of Allergology, Clinical Immunology & Pneumology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
⁹ Department of Internal Medicine and Clinical Complexities, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.
¹⁰ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
¹¹ Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹² UOSD Malattie Respiratorie "Federico II", Ospedale Monaldi, AO Dei Colli, Naples, Italy.
¹³ Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy.
¹⁴ Unit of Otolaryngology, University of Foggia, Foggia, Italy.
¹⁵ Unit of Otolaryngology, University Hospital "San Giovanni di Dio e Ruggi, D'Aragona", Salerno, Italy.
¹⁶ Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁷ ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy.
¹⁸ ENT Unit, Azienda USL di Bologna, Ospedale Bellaria, Bologna, Italy.
¹⁹ Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy.
²⁰ Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
²¹ Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Policlinico "G. Rodolico - San Marco" University Hospital, Catania, Italy.
²² Institute of Respiratory Diseases, Department DIBRAIN, University of Medicine, Bari, Italy.
²³ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
²⁴ Regional Reference Center for Allergic and Immunological Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy.
²⁵ DISCLIMO, Università Politecnica delle Marche, Italy; Allergy Unit, Department of Internal Medicine, University Hospital AOU Delle Marche, Ancona, Italy.
²⁶ Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy.
²⁷ Department of Neurosciences, Section of Otolaryngology, University of Padua, Padua, Italy.
²⁸ Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy.
²⁹ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
³⁰ UOSD Allergology and Clinical Immunology, Department of Abdominal and Endocrine-Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³¹ Section of Respiratory Diseases and Allergology - Department of Internal Medicine (DIMI), University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy.
³² Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
³³ Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy.
³⁴ Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy.
³⁵ Department of Otolaryngology, AOU Careggi, Florence, Italy.
³⁶ Respiratory Medicine Unit, ASST Papa Giovanni XXIII, Bergamo; Health Science Department, University of Milan.
³⁷ ENT Department, University Tor Vergata, Rome, Italy.
³⁸ Department of Pulmonary Interstitial Diseases, San Camillo Forlanini Hospital, Rome, Italy.
³⁹ Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy.
⁴⁰ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
⁴¹ IRCCS Policlinico San Matteo, Pavia, Italy.

PMID: 41178486
PMCID: PMC12581958
DOI: 10.14639/0392-100X-A973

Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

Eugenio De Corso et al. Acta Otorhinolaryngol Ital. 2025 Oct.

. 2025 Oct;45(5):339-348.

doi: 10.14639/0392-100X-A973.

Authors

Affiliations

¹ Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli Hospital IRCCS, Rome, Italy.
² Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASST Rhodense, Garbagnate Milanese (MI), Italy.
³ Otorhinolaryngology Unit, Head and Neck Department, ASST Santi Paolo e Carlo Hospital, Milan, Italy.
⁴ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
⁵ Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, Naples, Italy.
⁶ Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy.
⁷ Department 1 DISC, Otorhinolaryngology Unit, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy.
⁸ Departmental Unit of Allergology, Clinical Immunology & Pneumology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
⁹ Department of Internal Medicine and Clinical Complexities, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.
¹⁰ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
¹¹ Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹² UOSD Malattie Respiratorie "Federico II", Ospedale Monaldi, AO Dei Colli, Naples, Italy.
¹³ Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy.
¹⁴ Unit of Otolaryngology, University of Foggia, Foggia, Italy.
¹⁵ Unit of Otolaryngology, University Hospital "San Giovanni di Dio e Ruggi, D'Aragona", Salerno, Italy.
¹⁶ Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
¹⁷ ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy.
¹⁸ ENT Unit, Azienda USL di Bologna, Ospedale Bellaria, Bologna, Italy.
¹⁹ Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy.
²⁰ Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
²¹ Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Policlinico "G. Rodolico - San Marco" University Hospital, Catania, Italy.
²² Institute of Respiratory Diseases, Department DIBRAIN, University of Medicine, Bari, Italy.
²³ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
²⁴ Regional Reference Center for Allergic and Immunological Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy.
²⁵ DISCLIMO, Università Politecnica delle Marche, Italy; Allergy Unit, Department of Internal Medicine, University Hospital AOU Delle Marche, Ancona, Italy.
²⁶ Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy.
²⁷ Department of Neurosciences, Section of Otolaryngology, University of Padua, Padua, Italy.
²⁸ Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy.
²⁹ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
³⁰ UOSD Allergology and Clinical Immunology, Department of Abdominal and Endocrine-Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³¹ Section of Respiratory Diseases and Allergology - Department of Internal Medicine (DIMI), University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy.
³² Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
³³ Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy.
³⁴ Unit of Otorhinolaryngology and Head-Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy.
³⁵ Department of Otolaryngology, AOU Careggi, Florence, Italy.
³⁶ Respiratory Medicine Unit, ASST Papa Giovanni XXIII, Bergamo; Health Science Department, University of Milan.
³⁷ ENT Department, University Tor Vergata, Rome, Italy.
³⁸ Department of Pulmonary Interstitial Diseases, San Camillo Forlanini Hospital, Rome, Italy.
³⁹ Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy.
⁴⁰ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
⁴¹ IRCCS Policlinico San Matteo, Pavia, Italy.

PMID: 41178486
PMCID: PMC12581958
DOI: 10.14639/0392-100X-A973

Abstract

Objective: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and share common underlying pathophysiological mechanisms. This study addresses challenges in the diagnosis and treatment of multimorbid patients with CRSwNP and asthma providing new insights for their management.

Methods: Using a modified Delphi method, a scientific board of 40 Italian clinicians (pulmonologists, allergists/clinical immunologists, and ear, nose, and throat specialists) developed consensus statements regarding the multimorbid patient with severe CRSwNP and asthma and including the disease burden, assessment, treatment and multidisciplinary management of multimorbid patients.

Results: All statements reached consensus. Experts acknowledged the substantial disease burden, the key pathophysiological role of type 2 inflammation in multimorbid patients and the need for multidisciplinary care. The use of biologics represents a highly effective therapeutic opportunity for patients with comorbidities, optimising overall outcomes. Integrated care pathways and regular multidisciplinary re-assessment were deemed essential for treatment decisions and improved care in multimorbid patients.

Conclusions: This consensus highlights the value of a multidisciplinary approach for multimorbid CRSwNP and asthma patients, advocating for endotype-driven therapies and standardised pathways in clinical practice.

Keywords: asthma; biologic therapy; chronic rhinosinusitis; comorbidities; nasal polyps; precision medicine.

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Conflict of interest statement

EDC, CC, VS: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Astrazeneca; CP: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Firma, Deca; EC: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, NOOS; ILM: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Chiesi; FRMC, MC, SG, FP, JWS, MG: lecture fees from Sanofi and GSK; GO: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi; GLF: lecture fees and participations in experts board meeting of Astrazeneca, Sanofi;AM: lecture fee of Sanofi; FM: has received research grants from AstraZeneca, Sanofi, GSK, Chiesi Farmaceutici and lecture fees and advisory board fees from AstraZeneca, Chiesi Farmaceutici, GSK, Lusofarmaco; GEC: has received research grants lecture fees and advisory board fees from AstraZeneca, BI, Menarini, Lusofarmaco, Chiesi, Glaxo-Smith-Kline, Guidotti, Sanofi; FDM: has received research grants lecture fees and advisory board fees from AstraZeneca, BI, Menarini, Neopharmed Gentili, Zambon, Chiesi, Glaxo-Smith-Kline, Guidotti, MSD, Sanofi; EN: lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Astrazeneca. Chiesi, Firma, Abbvie, LEO-Pharma. GWC reports research or clinical trials grants paid to his Institution from Menarini, AstraZeneca, GSK, Sanofi Genzyme and fees for lectures or advisory board participation from Menarini, AstraZeneca, CellTrion, Chiesi, Faes Farma, Firma, Genentech, Guidotti, GSK, HAL Allergy, Innovacaremd, Novartis, OM-Pharma, Red Maple, Sanofi-Aventis, Sanofi-Genzyme, Stallergenes-Greer and Uriach Pharma; AD: lecture fees and participations in experts board meeting of Glaxo Smith Kline, Novartis, Sanofi, Astra Zeneca; MBB: has received lecture fees and/or advisory board fees from AstraZeneca, Menarini, Chiesi, Glaxo-Smith-Kline, Sanofi; SDG: lecture fees and participation in expert board meeting of Chiesi, AstraZeneca, GSK, Novartis, Sanofi; lecture fees: DBV, Stallergenes. CM received fees as a speaker in national and international congresses from Astrazeneca, Sanofi, GSK, Chiesi, Menarini, Guidotti, Lusofarmaco, Berlin Chemie, Zambon, Boehringher; EP, JG, GP, DM, GM, CC: no conflict of interest; MC: has received fees from AstraZeneca for serving on advisory boards and speaker fees from GSK and Sanofi; MD: lecture fees and participations in experts board meeting of GSK, Sanofi, Astrazeneca, Chiesi; GCP, FMP: lecture fee per Sanofi, DECA e GSK; AV: received lecture fees and advisory board fees from Sanofi, AstraZeneca, Glaxo-Smith-Kline, Firma; AM: received lecture fees and advisory board fees from Sanofi, AstraZeneca, Glaxo-Smith-Kline, Novartis, Chiesi; DB: received lecture fees from AstraZeneca, Chiesi, Glaxo Smith Kline, Guidotti, Grifols, Menarini, Novartis AG, Sanofi; MB,MC: has nothing to disclose.

Figures

**Cover figure.**
Framework for an integrated, multidisciplinary approach to optimise care in multimorbid patients.

See this image and copyright information in PMC

References

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Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

Affiliations

Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical