BACKGROUND: Biologicals have revolutionized care for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, real-world efficacy (RWE) data of dupilumab in patients who switch to dupilumab after...BACKGROUND: Biologicals have revolutionized care for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, real-world efficacy (RWE) data of dupilumab in patients who switch to dupilumab after having no or minimal therapeutic response to either omalizumab or mepolizumab are lacking. No comparison has been performed between patients switching from omalizumab or mepolizumab to dupilumab and those receiving dupilumab as their first biological. AIM: 55 CRSwNP patients receiving dupilumab in the RELIBIO trial were divided into those who were biological naive (n = 30) and those who showed no to poor therapeutic response to 6 months therapy with either omalizumab or mepolizumab (n = 25), with evaluation of the following parameters at baseline and 6 months: SNOT-22 scores, nasal congestion scores (NCS), VAS scores for nasal obstruction, smell loss and postnasal drip, ACQ-5, AQLQ and total nasal polyp scores (TNPS). We determined disease control and therapeutic response evaluation (TRE) at 6 months for both groups using the EUFOREA/EPOS criteria. RESULTS: Dupilumab showed significant improvements on all patient-reported outcome measures (PROMs) and TNPS in both groups. When comparing the efficacy between switchers and naive patients, dupilumab showed equal efficacy in both groups on SNOT-22, TNPS, NCS, VAS scores for smell loss, nasal blockage and postnasal drip, ACQ-5 and AQLQ. A good to excellent therapeutic response at 6 months was observed in 67% of switchers compared to 97% of the biological naive patients. Regarding disease control at 6 months, we observed 44% being controlled in the switchers and 67% in the biological naive group, with smell loss being the main reason for not being controlled. CONCLUSIONS: This prospective RWE study shows that dupilumab significantly reduced symptom severity and nasal polyp scores in CRSwNP patients at 6 months of therapy, also in those showing a minimal therapeutic response to mepolizumab or omalizumab. Patients in the biologic naive group showed a higher likelihood of achieving disease control.
BACKGROUND: Biological therapy is a newer line of treatment that has been utilized in practice for patients with chronic rhinosinusitis with nasal polyps, showing excellent results. However, some patients with chronic rh...BACKGROUND: Biological therapy is a newer line of treatment that has been utilized in practice for patients with chronic rhinosinusitis with nasal polyps, showing excellent results. However, some patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) do not respond to this therapy. Hence, this study aims to evaluate the efficacy and safety of biological switching in these patients. METHODOLOGY: Using the Web of Science, Cochrane, MEDLINE, and Embase databases, we analyzed studies involving biological switching in CRSwNP patients published up to June 2025. The studies were extracted, and data were pooled for meta-analysis. RESULTS: Of 3,367 studies identified, eight studies (involving 470 patients) were included in the systematic review, four of which were included in the meta-analysis. The results showed that the most common reason for switching was insufficient CRS symptom control (59.7%), followed by undesirable side effects (10.8%). The findings demonstrated dramatic effects of biological switching in terms of the SNOT-22 score, with a mean improvement of 71.4%. In addition, studies that switched patients to dupilumab showed significant improvement after switching in both SNOT-22 and nasal polyp scores. Overall, the success rate of biological switching ranged from 59.6% to 100%, with an average success rate of 79.2%. CONCLUSIONS: This review demonstrated the effect of biological switching as an option for patients with refractory CRSwNP or those experiencing biological side effects. These findings highlight a new therapeutic alternative that can serve as a fundamental choice when managing CRSwNP patients.
BACKGROUND: This study aimed to examine whether chronic obstructive pulmonary disease (COPD) is associated with the subsequentdevelopment of chronic rhinosinusitis (CRS) among Korean adults. METHODOLOGY: Using the 2002-2...BACKGROUND: This study aimed to examine whether chronic obstructive pulmonary disease (COPD) is associated with the subsequentdevelopment of chronic rhinosinusitis (CRS) among Korean adults. METHODOLOGY: Using the 2002-2019 Korean National Health Insurance database, we conducted a retrospective cohort study. Individuals with COPD, definted by relevant ICD-10 codes recorded on at least two occasions together with at least two prescriptions for COPD-related medicines (n=615,706), were matched with control participants (n=2,184,000) by age, sex, income, and region of residence. The incidence of CRS with and without nasal polyps was evaluated in both COPD and control groups. Hazard ratios (HRs) were estimated using stratified Cox proportional hazards models, and prespecified subgroup analyses were conducted. RESULTS: The incidence rate of CRS was higher in patients with COPD than in control participants. After adjustment, the HR for CRS was significantly higher in the COPD group compared with the control group. Likewise, the HRs for CRS with nasal polyps and CRS without nasal polyps were also significantly higher in the COPD group than in the control group. Statistical significance was observed in all subgroups according to age, sex, income, and region of residence. Kaplan-Meier analyses showed a higher cumulative incidence in participants with COPD. CONCLUSIONS: In this nationwide Korean cohort, COPD was associated with a higher incidence of CRS, both with and without nasal polyps.
BACKGROUND: Although evidence has implicated air pollution in both upper and lower airway inflammation, regulatory efforts have primarily emphasized lower-airway outcomes. We characterize the association between ambient...BACKGROUND: Although evidence has implicated air pollution in both upper and lower airway inflammation, regulatory efforts have primarily emphasized lower-airway outcomes. We characterize the association between ambient pollutant levels and outpatient burden of chronic rhinosinusitis (CRS) and asthma across the US. METHODOLOGY: We conducted an ecological cohort study of US metropolitan statistical areas (MSAs) between 2007 and 2020. Annual outpatient claims were obtained from the MarketScan database and linked with data from the Environmental Protection Agency (EPA) monitoring network. For each MSA, annual outpatient visits for CRS and asthma were normalized to the number of wellness check visits (CRS-OV, asthma-OV). Daily 365-day rolling averages were calculated for each EPA-monitored pollutants. Mixed-effects models estimated associations with CRS-OV and asthma-OV, and additive pollutant interactions. RESULTS: Controlling for community health indicators, higher levels of all EPA monitored pollutants predicted increased CRS-OV and asthma-OV. Adjusting for co-pollutant levels, PM2.5 (particles ≤2.5μm in diameter) and SO2 (gas from fossil fuel combustion) remained independently predictive. Each standard deviation increase in PM2.5 corresponded to 15% and 6% increases in CRS-OV and asthma-OV, while each standard deviation increase in SO₂ corresponded to 12% and 10%, respectively. Positive additive interaction between PM2.5 and SO2 was observed for both CRS-OV and asthma-OV. CONCLUSIONS: While EPA-monitored pollutants were broadly associated with outpatient burden, PM2.5 and SO2 emerged as independent and synergistic predictors after co-pollutant adjustment, with stronger associations for CRS compared to asthma. Regulatory focus should extend beyond lower-airway outcomes and include upper-airway morbidity as a critical indicator of pollution-related burden.
Skin prick testing (SPT) is the gold standard for diagnosing allergic sensitization in individuals with a suspected airborne allergy (1). Skin tests are used as first option in 90% of individuals suffering from respirato...Skin prick testing (SPT) is the gold standard for diagnosing allergic sensitization in individuals with a suspected airborne allergy (1). Skin tests are used as first option in 90% of individuals suffering from respiratory allergies and almost two-third of all types of allergies (2). However, its accuracy highly depends on the operator, causing variability during pricking and readout. S.P.A.T. or skin prick automated test standardises the SPT procedure and has been clinically validated (3).
INTRODUCTION: Considerable work has been done to delineate risk factors for cerebrospinal fluid (CSF) leak after endoscopic skull base surgery (ESBS). Little work has been done to evaluate factors that influence the timi...INTRODUCTION: Considerable work has been done to delineate risk factors for cerebrospinal fluid (CSF) leak after endoscopic skull base surgery (ESBS). Little work has been done to evaluate factors that influence the timing of CSF leaks after ESBS. The timing of when CSF leaks occur may have important implications on postoperative precautions and managing the underlying etiology. The aim of this multi-institutional study was to evaluate postoperative CSF leaks after ESBS to determine timing of occurrence and factors that influence when leaks occur. METHODS: Data were collected retrospectively on patients diagnosed with CSF leak after ESBS at 5 institutions from 2010 to 2024. Variables including patient demographics, tumour and defect dimensions, defect location, reconstruction, timing of CSF leak, management of leak, and rates of meningitis were collected. RESULTS: A total of 184 patients were analysed. The median postoperative day (POD) when CSF leak occurred was 7. Prior radiation, BMI less then 25, recurrent tumours, large defect size, defects located in the clivus, and CSF diversion were all associated with delays in presentation of postoperative CSF leak (all p less then 0.05). On multivariate analysis, BMI and history of radiation retained significance in association with delayed CSF leak. Timing of leak also appeared to be impacted by the number of, and specific layers used in reconstruction. CONCLUSIONS: Several factors were found to impact the timing of CSF leak after ESBS including patient, intraoperative, and postoperative factors. Understanding timing of postoperative CSF leaks may provide insights for prevention and secondary management.
BACKGROUND: This study assessed the prognostic value of early Epstein-Barr virus (EBV) DNA dynamics combined with Response Evaluation Criteria in Solid Tumours (RECIST)-based radiographic response in patients with recurr...BACKGROUND: This study assessed the prognostic value of early Epstein-Barr virus (EBV) DNA dynamics combined with Response Evaluation Criteria in Solid Tumours (RECIST)-based radiographic response in patients with recurrent/metastatic nasopharyngeal carcinoma (R/M NPC) receiving immunotherapy, to refine risk stratification. METHODOLOGY: A real-world cohort of 306 patients with R/M NPC and detectable EBV DNA at baseline received PD-1 monoclonal antibodies (PD-1 mAbs), alone or with chemotherapy. EBV DNA and radiological assessments were performed at baseline and after two therapy cycles. Biological responses based on EBV DNA were compared with RECIST evaluations. Survival outcomes were analysed using inverse probability treatment weighting, and a Cox regression model was developed incorporating baseline features and early responses. RESULTS: Among 306 patients, 174 achieved complete biological response (cBR), and 203 achieved complete or partial radiological response (CR/PR). Patients achieving both cBR and CR/PR had the most favourable progression-free survival. Early cBR was the dominant prognostic factor for overall survival, whereas radiological response did not affect overall survival within biological response strata. A prediction model integrating baseline features, radiological, and biological responses achieved an optimismcorrected C-index, surpassing models with baseline features alone, baseline plus radiological response, and baseline with biological response. CONCLUSIONS: Early biological response by EBV DNA was a stronger prognosticator than radiological response in PD-1 mAbs-treated R/M NPC. Combining baseline clinical features with biological and radiological responses improved survival prediction.
BACKGROUND: Ciliary abnormalities are implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but whether these changes are site-specific traits or confined to specific cell populations remai...BACKGROUND: Ciliary abnormalities are implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but whether these changes are site-specific traits or confined to specific cell populations remains unknown. Here, we systematically examined ciliated cells throughout the sinonasal tract to characterize disease-specific ciliary alterations and identify a distinct population of elongated ciliated cells in nasal polyps (NPs). METHODS: Nasal biopsy specimens were obtained from patients with CRSwNP (n=32) and non-CRSwNP (n=22). hNECs were differentiated at the air-liquid interface (ALI). Tissue sections, cytospin preparations, and ALI cultures were immunostained for α-tubulin. Cilia length, length of horizontal axis, and length of vertical axis of ciliated cells were recorded. RESULTS: Cilia length was significantly greater in CRSwNP patients than in non-CRSwNP controls (8.17 ± 3.35 μm vs. 5.67 ± 1.64 μm). Within NPs tissues, we identified a distinct population of elongated ciliated cells (ECCs) exhibiting marked inner/outer cilia length disparity, with outer cilia reaching up to 20.0 μm. These ECCs accounted for 8.10% ± 3.56% of total ciliated cells in NPs. Notably, ECCs-like cells were also detected in polypoid-transformed mucosa adjacent to NPs and persisted after ALI culture. In contrast, ciliated cell dimensions did not differ between groups or across the nasal anatomical sites examined. CONCLUSION: A population of ciliated cells characterized by abnormally elongated cilia and concomitant impairment of ciliary function can be found in NPs, which may represent a key pathogenic factor in the development and progression of CRSwNP.
BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often undergo multiple nasal surgeries. The Phase III SYNAPSE study (GSK ID:205687; NCT0308579) demonstrated that mepolizumab reduces the need f...BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often undergo multiple nasal surgeries. The Phase III SYNAPSE study (GSK ID:205687; NCT0308579) demonstrated that mepolizumab reduces the need for repeat surgery. We explored whether outcomes differed based on the number of prior surgeries. METHODOLOGY: This post hoc analysis of SYNAPSE stratified patients by history of 1 or >1 prior surgery. Patients were randomised to receive mepolizumab or placebo every 4 weeks, alongside standard of care, for 52 weeks. Outcomes included change from baseline in endoscopic nasal polyp (NP) score, visual analogue scale (VAS) scores for nasal obstruction, loss of smell and overall symptoms, Sino-Nasal Outcome Test-22 (SNOT-22), and time to repeat surgery and/or oral corticosteroid (OCS) use. RESULTS: 189 patients had 1 prior surgery (108 mepolizumab; 81 placebo) and 218 had >1 prior surgery (98; 120). In both subgroups, mepolizumab significantly improved mean changes versus placebo in NP, nasal obstruction, loss of smell VAS, overall symptom VAS, and SNOT-22. Significant reductions in risk of repeat surgery and requiring OCS were observed with mepolizumab versus placebo in patients with 1 prior surgery. CONCLUSIONS: Mepolizumab improves outcomes in patients with CRSwNP with one or multiple prior surgeries; however, may offer greater benefit when initiated after a single surgery.
On August 4th, 2020, Beirut witnessed the largest non-nuclear explosion in modern history. The explosion resulted in the release of large amounts of gases and particulate matters (PM) including ammonia and nitrogen oxide...On August 4th, 2020, Beirut witnessed the largest non-nuclear explosion in modern history. The explosion resulted in the release of large amounts of gases and particulate matters (PM) including ammonia and nitrogen oxides (NOx), as well as pure oxygen (O2). NO2 conversion into nitric and nitrous acids has been shown to damage the alveolar structure in distal airways. The goal of this study is to investigate the early and late, subjec-tive and objective, effects of the explosion and particulate mat-ter exposure on the upper airway, specifically chronic rhinitis.
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness and cost-efficiency from the Spanish National Health System (NHS) perspective. METHODOLOGY: An economic evaluation was conducted in severe CRSwNP, following Spanish-NHS guidelines. Data came from a tertiary-hospital with 10-year projections. Effectiveness was measured as reduction in the Sinonasal Outcome Test-22 (SNOT-22). Cost-utility analysis used quality-adjusted life years (QALYs). Micro-costing was applied for ESS, while annual drug costs were considered for biologics. Sensitivity analyses tested robustness. RESULTS: 89 patients were included (63 ESS, 26 biologics). After 2-years, both strategies achieved similar SNOT-22 improvements (-31.8 ESS, -31.0 biologics). Costs were far lower for ESS (€5,302.78) than biologics (€27,198.23), making biologics less efficient despite comparable benefit. The 2-year incremental cost-utility ratio (ICUR) for biologics was €1.2 million/QALY, above accepted thresholds. At 10-years, biologics yielded 2.75 QALYs at an incremental cost of €108,917.62 (ICUR €39,592/QALY). Sensitivity ana-lyses showed that biologics generally remained above commonly accepted willingness-to-pay thresholds, although substantial price reductions (up to 40%) allowed ICURs to approach the upper limit of acceptability. CONCLUSIONS: Both treatments provide meaningful improvement. ESS remained the less costly strategy and was more efficient over the short term, whereas long-term projections showed higher QALY gains with biologics at substantially greater cost. Within Spanish- NHS, biologics may approach cost-effectiveness only under favorable pricing assumptions and should be reserved for patients with contraindications or persistent disease after ESS.
On behalf of all co-authors, I sincerely thank Dr. Hong for his insightful comments regarding our article and discuss the po-tential role of nutritional support as a confounder in our study (1). First, we recognized the...On behalf of all co-authors, I sincerely thank Dr. Hong for his insightful comments regarding our article and discuss the po-tential role of nutritional support as a confounder in our study (1). First, we recognized the prognostic importance of nutritional and inflammatory status in our cohort, as evidenced by our inclusion of baseline albumin (ALB) and the C-reactive protein/albumin (CRP/ALB) ratio as covariates in our propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. Both were identified as independent adverse prognostic factors in multivariate models. These markers were adjusted for in our models to account for baseline nutritional and inflammatory status. Moreover, our PSM and IPTW analyses successfully balanced the groups for key baseline nutritional markers, suggesting that the groups were comparable in terms of underlying nutritional risk at treatment initiation.
We read with great interest the randomized trial by Homoe et al. evaluating mepolizumab with or without functional endo-scopic sinus surgery (FESS) for severe uncontrolled CRSwNP (1), integrating patient-reported sleep o...We read with great interest the randomized trial by Homoe et al. evaluating mepolizumab with or without functional endo-scopic sinus surgery (FESS) for severe uncontrolled CRSwNP (1), integrating patient-reported sleep outcomes (ESS, FOSQ-10, SNOT-22 sleep items) with WatchPAT-derived indices of sleep-disordered breathing (AHI/ODI). The study addresses a clinically frequent scenario in which patients report prominent fatigue and "poor sleep", while OSA may coexist and require indepen-dent management.
BACKGROUND: Nasal septal perforation (NSP) is commonly associated with nasal obstruction, crusting and epistaxis. Research on its impact on olfactory function remains limited. This study aims to evaluate the sense of sme...BACKGROUND: Nasal septal perforation (NSP) is commonly associated with nasal obstruction, crusting and epistaxis. Research on its impact on olfactory function remains limited. This study aims to evaluate the sense of smell in patients with NSP and identify factors associated with the olfactory dysfunction. METHODOLOGY: Cross-sectional study of patients with symptomatic NSP and a control group was conducted at Clinic and Teknon hospitals in Barcelona from 2017 to 2024. Data collected included sex, age, comorbidities, body mass index (BMI), NSP aetiology, SNOT-22 and NOSE-Perf questionnaires. Olfactory function was assessed using visual analogue scale (VAS) and the Barcelona Smell Test 24 (BAST-24). NSP size and position were determined through nasal endoscopy and sinus computed tomography scan. RESULTS: 123 patients with symptomatic NSP and 74 healthy controls were included. Intranasal cocaine use was the most common aetiology. Olfactory dysfunction was observed in 26 patients (21.1%) for detection, 26 (21.1%) for memory, and 85 (69.1%) for identification, significantly different from control group. Patients with olfactory dysfunction presented trigeminal detection and identification impairment in 34% and 51%, respectively. In multivariate analysis, significant differences were found in olfactory identification based on NSP area and BMI, corrected by aetiology. A moderate correlation was found between olfactory identifica-tion with VAS, SNOT-22 item 21 and NOSE-Perf item 10. Olfactory identification was significantly correlated with trigeminal scores. CONCLUSIONS: NSP significantly affects olfactory and trigeminal function. Lower identification outcomes were associated with larger NSP area and higher BMI, independently of aetiology.
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a refractory, relapsing upper airway inflammatory disorder cha-racterized by prominent tissue remodeling. Current therapeutic options remain suboptimal. We...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a refractory, relapsing upper airway inflammatory disorder cha-racterized by prominent tissue remodeling. Current therapeutic options remain suboptimal. We aimed to identify novel potential targets and biomarkers using integrative multi-omics. METHODOLOGY: We performed Mendelian randomization (MR) analyses integrating blood expression quantitative trait loci (eQTL) from eQTLGen and plasma protein quantitative trait loci (pQTL) from deCODE with nasal polyps (NP) genome-wide association study data from 8,496 NP patients and 371,520 controls. Significant targets underwent validation via bulk/single-cell RNA sequen-cing, immunohistochemistry, and immunofluorescence. RESULTS: MR analyses identified 6 targets causally linked to NP risk in both eQTL and pQTL analyses. Therein, cathepsin S (CTSS) increased the risk of NP, exclusively demonstrating colocalization with NP and exhibiting significant upregulation in NP tissue. Single-cell data showed CTSS mainly express in monocyte/macrophages, and CTSS-high subsets enriched in CRSwNP vs. Control. Immunohistochemistry and immunofluorescence further confirmed high CTSS expression in NP. Moreover, CTSS expression cor-related with tissue remodeling pathways and associated with CRSwNP clinical severity. CONCLUSIONS: CTSS may contribute to the pathogenesis of CRSwNP by modulating tissue remodeling. CTSS is a noval biomarker for CRSwNP.
BACKGROUND: Growing awareness of permanent olfactory dysfunction has raised concerns about its impact on quality of life (QoL). This study examined the effect of permanent anosmia on QoL by comparing patients with acquir...BACKGROUND: Growing awareness of permanent olfactory dysfunction has raised concerns about its impact on quality of life (QoL). This study examined the effect of permanent anosmia on QoL by comparing patients with acquired anosmia of varying durations, including cases persisting for over a decade and cases of isolated congenital anosmia (ICA). METHODOLOGY: A total of 59 patients with post-viral or idiopathic anosmia who sought medical evaluation due to olfactory com-plaints completed the Questionnaire of Olfactory Disorders (QOD), which measured impairment, coping ability, and subjective disturbance. Patients were categorized into three groups: persistent acquired anosmia (PerA, duration 6 months-2 years), prolon-ged acquired anosmia (ProA, duration ≥10 years), and ICA to reflect distinct populations. Patients with intermediate or uncertain duration were excluded to avoid recall bias. RESULTS: Perceived impairment, as reflected by QOD-NS and work domain of QOD-VAS, was higher in the PerA and ProA groups than in the ICA group. No significant differences in QOD-NS and QOD-VAS were observed between PerA and ProA groups. The ProA group exhibited better coping ability, as indicated by higher QOD-PS scores, than did the PerA group, suggesting coping over time. Coping scores in the ProA and ICA groups were comparable, indicating long-term adjustment in anosmic individuals. CONCLUSIONS: Acquired anosmia has a greater impact on QoL than does congenital anosmia. Individuals with prolonged acquired anosmia exhibited better subjective coping.
The new issue of Rhinology reflects the wide range of topics covered by our field, spanning epistaxis, fungal sinusitis, and olfaction, as well as tissue biomarkers that characterize inflammatory processes. As always, th...The new issue of Rhinology reflects the wide range of topics covered by our field, spanning epistaxis, fungal sinusitis, and olfaction, as well as tissue biomarkers that characterize inflammatory processes. As always, the studies are insightful, methodologically sound, and offer new perspectives for the treatment of the diseases that occupy rhinologists. Continuous progress in our field promises considerable benefits for our patients.
CONCLUSION: The self-MOQ is a sufficient screening tool for OD after SARS-CoV-2 infection. Patients with persistent OD show signi-ficantly poorer QoL than those without. CLINICAL IMPLICATIONS: Olfactory function can be a...CONCLUSION: The self-MOQ is a sufficient screening tool for OD after SARS-CoV-2 infection. Patients with persistent OD show signi-ficantly poorer QoL than those without. CLINICAL IMPLICATIONS: Olfactory function can be assessed in patients with COVID-19 using a simple 5-item questionnaire (self-MOQ). Patients with OD show reduced QoL. CAPSULE SUMMARY: In our population-based cross-sectional study of 667 patients with PCR-confirmed SARS-CoV-2 infection, par-ticipants with persistent OD had significantly poorer OF-related QoL. The self-MOQ is a simple, valid and reliable means to screen OD in patients with COVID-19.
BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide in adults, but development of CRS has rarely been studied longitudinally in birth-cohorts. The aim was to investigate development of upper airway symptoms from...BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide in adults, but development of CRS has rarely been studied longitudinally in birth-cohorts. The aim was to investigate development of upper airway symptoms from childhood to young adulthood and to identify early risk factors for CRS at 24 years, in a population-based birth cohort. METHOD: 3037 subjects from the BAMSE (Barn/children Allergy Milieu Stockholm Epidemiology) cohort had complete question-naire answers on CRS at the 24-year-follow-up. Subjects fulfilling European Position Paper on Rhinosinusitis (EPOS) criteria of CRS at 16 and/or 24 years (n=141) were invited to a clinical examination with nasal endoscopy and interviews. Among these, 68 had clinically verified CRS symptoms. Symptoms and clinical status were compared with questionnaire-based answers on symptoms and potential risk factors for CRS, in early childhood. RESULTS: Among subjects with CRS symptoms at 24 years, > 60% reported upper airway symptoms already at 16 years. In the same group, a significant association was observed with a history of otitis media < 1 year and with heredity for atopic diseases. Moreover, the proportion of atopic features such as asthma, allergic rhinitis and eczema were significantly higher at 4, 8 and 16 years in this group. No clear association was found between CRS at 24 years and early RS infection, antibiotic use.
BACKGROUND: Monoclonal antibody therapies targeting type 2 inflammation for chronic rhinosinusitis with nasal polyps (CRSwNP) have shown efficacy in randomized controlled trials (RCTs), however prospective real-world com...BACKGROUND: Monoclonal antibody therapies targeting type 2 inflammation for chronic rhinosinusitis with nasal polyps (CRSwNP) have shown efficacy in randomized controlled trials (RCTs), however prospective real-world comparative data across all appro-ved biologics remain limited. We aimed to evaluate the real-world effectiveness of omalizumab, mepolizumab, and dupilumab in patients with severe CRSwNP. METHODOLOGY: A prospective, multicentre, real-world phase IV study in Belgium, enrolling 360 patients with severe CRSwNP initiating treatment with omalizumab (n=65), mepolizumab (n=242), or dupilumab (n=53) between March 2022 and April 2025. Clinical data were collected at baseline and after 6 months. The therapeutic response was evaluated based on EUFOREA criteria. RESULTS: After 6 months, nasal polyp score (NPS), olfactory function, and patient-reported outcomes improved across all biologics, with concurrent improvements in asthma control within each treatment group. A good-to-excellent multidomain therapeutic response was achieved in 51% of patients, and treatment continuation beyond 6 months was observed in 74% of omalizumab-, 81% of mepolizumab-, and 92% of dupilumab-treated patients. No severe adverse events were reported. CONCLUSION: In this real-world cohort, the three registered biologics provided significant clinical benefit in severe CRSwNP, with numerically larger improvements observed in patients treated with dupilumab.