Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights

Abstract

Sanna Toppila-Salmi,1,2 Leif Bjermer,3 Lars-Olaf Cardell,4,5 Anders Cervin,6,7 Tuuli Heinikari,2 Lauri Lehtimäki,8,9 Marie Lundberg,10 Jens C Richter,11 Saara Sillanpää9,12 1Department of Otorhinolaryngology, Kuopio University Hospital and School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; 2Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; 3Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 4Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; 5Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; 6Centre for Clinical Research, University of Queensland, Brisbane, Australia; 7Faculty of Medicine, Lund University, Lund, Sweden; 8Allergy Centre, Tampere University Hospital, Tampere, Finland; 9Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; 10Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; 11Department of Asthma and Allergology, Clinic of Lung Medicine, Skåne University Hospital and Lund University, Lund, Sweden; 12Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, FinlandCorrespondence: Sanna Toppila-Salmi, Haartmaninkatu 3, Haartman Institute, University of Helsinki, Helsinki, 00014, Finland, Email [email protected]: Severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disabling airway disease that significantly impacts patients’ lives through the severity of symptoms, the need for long-term medical treatment and the high risk of recurrence post-surgery. Biological agents targeting type 2 immune responses underlying the pathogenesis of CRSwNP have shown effectiveness in reducing polyp size and eosinophilic infiltrate, and in decreasing the need for additional sinus surgeries. However, despite recent progress in understanding and treating the disease, type 2 inflammation-driven severe CRSwNP continues to pose challenges to clinical management due to several factors such as persistent inflammation, polyp recurrence, heterogeneity of disease, and comorbidities. This article presents the findings of a scientific discussion involving a panel of ear, nose and throat (ENT) specialists and pulmonologists across Sweden and Finland. The discussion aimed to explore current management practices for type 2 inflammation-driven severe CRSwNP in the Nordic region. The main topics examined encompassed screening and referral, measurements of disease control, treatment goals, and future perspectives. The experts emphasized the importance of a collaborative approach in the management of this challenging patient population. The discussion also revealed a need to broaden treatment options for patients with type 2 inflammation-driven CRSwNP and comorbid conditions with shared type 2 pathophysiology. In light of the supporting evidence, a shift in the disease model from the presence of polyps to that of type 2 inflammation may be warranted. Overall, this discussion provides valuable insights for the scientific community and can potentially guide the future management of CRSwNP.Keywords: chronic rhinosinusitis, type 2 immunity, surgery, biological therapy, Nordic countries, collaboration

Keywords

• chronic rhinosinusitis
• type 2 immunity
• surgery
• biological therapy
• nordic countries
• collaboration