Impact of sinus surgery on type 2 airway and systemic inflammation in asthma

Hamada, Kazuki; Oishi, Keiji; Chikumoto, Ayumi; Murakawa, Keita; Ohteru, Yuichi; Matsuda, Kazuki; Uehara, Sho; Suetake, Ryo; Ohata, Shuichiro; Murata, Yoriyuki; Yamaji, Yoshikazu; Asami‐Noyama, Maki; Ito, Kosuke; Edakuni, Nobutaka; Hirano, Tsunahiko; Matsunaga, Kazuto

doi:10.1080/02770903.2020.1729380

Cited by 23 publications

(19 citation statements)

References 38 publications

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“…Interestingly, a study evaluating the impact of sinus surgery for CRS on asthma control showed that patients with worse preoperative asthma control level could have an additional positive effect from nasal surgery [ 37 ]. Moreover, recent evidence suggest how ESS seems to ameliorate asthma control in patients with CRSwNP and concomitant asthma by suppressing type-2 inflammation [ 38 ]. Besides, asthma severity is related with the risk of exacerbations in CRSwNP subjects and in patients with asthma functional parameters improve after nasal polyp surgery.…”

Section: Results and Discussion Of Patients’ Management Flowsmentioning

confidence: 99%

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Seccia

D’Amato

Scioscia

et al. 2022

JPM

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Chronic rhinosinusitis (CRS) is one of the most frequent comorbidities associated with asthma and it contributes to an amplified global disease burden in asthmatics. CRS prevalence is much higher in asthmatic patients compared to the general population and it is more frequently related to severe asthma, especially in presence of nasal polyps (chronic rhinosinusitis with nasal polyps, CRSwNP). Moreover, asthma exacerbation has a higher occurrence in CRSwNP. From a pathologic point of view, CRS and asthma share similar and connected mechanisms (e.g., type-2 inflammation). A multidisciplinary approach represents a crucial aspect for the optimal management of patients with concomitant asthma and CRSwNP and improvement of patient quality of life. An Italian panel of clinicians with different clinical expertise (pulmonologists, ear, nose and throat specialists, immunologists and allergy physicians) identified three different profiles of patients with coexisting asthma and nasal symptoms and discussed the specific tracks to guide a comprehensive approach to their diagnostic and therapeutic management. Currently available biological agents for the treatment of severe asthma act either on eosinophil-centered signaling network or type-2 inflammation, resulting to be effective also in CRSwNP and representing a valid option for patients with concomitant conditions.

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Section: Results and Discussion Of Patients’ Management Flowsmentioning

confidence: 99%

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Seccia

D’Amato

Scioscia

et al. 2022

JPM

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show abstract

“…1 C), it is plausible that improved upper airway ventilation contributes to the improvement in respiratory symptoms. Actually, there is considerable evidence that surgical treatment of the upper airway can reduce FeNO and serum eosinophil count and improve respiratory functions as well as respiratory symptoms in comorbid asthma [ 17 , 26 , 27 ]. As the potential mechanism, it has been postulated that treatment of CRSwNP affects asthma control by suppressing type-2 inflammation in the upper airway and the whole body.…”

Section: Discussionmentioning

confidence: 99%

Real-life effectiveness of dupilumab in patients with mild to moderate bronchial asthma comorbid with CRSwNP

et al. 2022

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Background Dupilumab, an anti-IL-4α receptor antibody, is a new treatment for severe or refractory asthma. However, real-world evidence on the efficacy of dupilumab in patients with mild to moderate bronchial asthma is lacking. Methods We retrospectively evaluated the effects of dupilumab in 62 patients who received dupilumab for eosinophilic sinusitis comorbid with asthma at a single centre in Japan. Type 2 inflammatory markers, ACT, respiratory function tests, and forced oscillation technique (FOT) were analysed before, three months after, and one year after dupilumab administration, mainly in patients with mild to moderate asthma. Results FEV1, %FEV1, %FVC, treatment steps for asthma and ACT improved significantly after three months of dupilumab treatment. FeNO was markedly decreased, whereas IgE and eosinophil counts showed no significant changes. Pre- and post-treatment respiratory resistance (Rrs) and respiratory reactance (Xrs) correlated significantly with FEV1. Improvement in %FEV1 was associated with higher FeNO and higher serum IgE before dupilumab treatment. Conclusion Dupilumab treatment for sinusitis may improve respiratory functions, asthma symptoms, and asthma treatment reduction, even if the associated bronchial asthma is not severe.

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“…Smoking and asthma comorbidities, including eosinophilic CRSwNP, adversely affect asthma control. 32 , 33 Accordingly, the deterioration of asthma control after discontinuation in case 2 might have been due to the comorbid eosinophilic CRSwNP and atopic dermatitis. Thus, the difference of clinical course between our two cases indicates that control of comorbidities in addition to asthma control may be of importance for the maintenance of a well-controlled condition after long-term biologic therapy, even if asthma control dramatically improved (ie super-responders).…”

Section: Discontinuation Of Biologics In Patients With Severe Asthmamentioning

confidence: 99%

Feasibility of Discontinuing Biologics in Severe Asthma: An Algorithmic Approach

Hamada¹,

Oishi²,

Murata³

et al. 2021

JAA

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In severe asthma with type 2 (T2) inflammation, biologics targeting key mediators of T2 inflammation, including interleukin (IL)-5, IL-4/IL-13, and immunoglobulin (Ig)E, remarkably improve the management of severe asthma, providing new insights into the clinical course of asthma such as disease modification and broad modulation of T2 inflammation. Once severe asthma has become a "controllable" condition, the question of discontinuation of biologics arises due to cost and side effects. The studies on discontinuing biologics in asthma demonstrate that some of patients successfully discontinue biologics, indicating that it is a feasible option in a subset of patients. Incorporating the evidence of discontinuation, we propose the criteria for the discontinuation of biologics. Our proposed criteria for the discontinuation of biologics consist of an absence of asthma symptoms (asthma control questionnaire [ACQ] score < 1.5 or asthma control test [ACT] score > 19), no asthma exacerbations, no use of oral corticosteroids, normalized spirometry (forced exhaled volume in 1 second [FEV 1 ] ≥ 80%), suppressed T2 inflammation (blood eosinophil counts < 300 μL and fractional exhaled nitric oxide [FeNO] < 50 ppb), and control of asthma comorbidities. Real-world evidence verified a subset of patients achieving highly wellcontrolled conditions after use of biologics, namely super-responders, who are candidates for the discontinuation of biologics. If super-responders meet all of the criteria, they are allowed to discontinue biological therapies. Our proposed algorithm may support physicians' treatment decisions for patients receiving biologics.

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Impact of sinus surgery on type 2 airway and systemic inflammation in asthma

Cited by 23 publications

References 38 publications

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach

Real-life effectiveness of dupilumab in patients with mild to moderate bronchial asthma comorbid with CRSwNP

Feasibility of Discontinuing Biologics in Severe Asthma: An Algorithmic Approach

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