Eosinophilia, asthma, NERD and the use of oral corticosteroids predict uncontrolled chronic rhinosinusitis with nasal polyps after surgery
Elina Penttilä,1,2 Saara Sillanpää,3 Seija I Vento,4 Jyri Myller,5 Anni Koskinen,4 Sari Hammarén-Malmi,4 Anu Laulajainen-Hongisto,4 Maija Hytönen,4 Annina Lyly,4,6 Markus Lilja,4 Paula Kauppi,6,7 Jura Numminen,3 Markus Rautiainen,3 Johanna Sahlman,1 Mikko Nuutinen,8 Sanna Toppila-Salmi,6,8 Paula Virkkula4,6
1 Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
2 University of Eastern Finland, Kuopio, Finland
3 Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
4 University Hospital, Helsinki, Finland
5 Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland 6 Skin and Allergy Hospital, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland
7 Department of Pulmonary Diseases, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
8 Haartman Institute, University of Helsinki, Helsinki, Finland
Abstract
Background: Severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenging condition to treat. The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020) has the following criteria when considering biological therapy for severe uncontrolled CRSwNP: eosinophilia, need for oral corticosteroids (OCS), symptom score, loss of sense of smell and co-morbid asthma.
Objective: This study aimed at finding associations of baseline factors with uncontrolled CRSwNP after endoscopic sinus surgery (ESS).
Methods: Electronic health record data of CRSwNP patients (N = 137) undergoing ESS in 2002–17 were used. Endpoints of uncontrolled CRSwNP were revision ESS, purchased OCS and antibiotic courses during follow up. Baseline factors were chosen based on EPOS2020 and the data available: nasal polyp (NP) eosinophilia, peripheral blood eosinophilia, co-existing asthma and/or non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD), need for OCS during the previous year, previous ESS, endoscopic NP score, and Lund-Mackay score of sinus computed tomography scans.
Results: During the follow-up of 10.1 ± 3.1 (mean ± standard deviation) years, 35 (25.5%) individuals underwent revision ESS. The best predictive model was obtained by a sum of baseline (1) blood eosinophilia ≥ 250 cells/μl and/or NP eosinophilia ≥ 30% (Eos), (2) asthma/NERD, and (3) ≥ 1 OCS/year. It was significantly associated with revision ESS, purchased doctor-prescribed OCS and antibiotic courses during follow-up.
Conclusion: We identified similar predictive variables for uncontrolled CRSwNP that are used in the EPOS2020 indications of biological therapy, thus suggesting that these estimates are usable in clinical practice.
Key words: asthma, chronic rhinosinusitis, computed tomography, eosinophilia, nasal polyp, sinusitis