Abstract
Severe asthma is associated to chronic rhinosinusitis with nasal polyps (CRSwNP).
OBJECTIVE: We sought to investigate whether asthma with nasal polyps and aspirin sensitivity was associated with a specific severe asthma phenotype.
METHODS. A prospective study in 2010-2011 by pneumonologists and ENT specialists in 23 centers, 492 asthmatics age 45(15) yo, 70.5% female, according to GINA: 17.3% intermittent and 82.7% persistent (24.6% mild, 31.4% moderate, and 26.7% severe). Asthma control by ACT.The allergic (AR) and non-allergic (NAR) rhinitis and chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps according to ARIA and EPOS, by symptoms, prick test, nasal endoscopy and sinus CT scan. Aspirin sensitivity (AIA)by clinical history.
RESULTS. 35% of severe asthma patients, predominantly in non-atopic (44%) reported CRSwNP (OR:3.4; p < 0.001). AIA was associated with severe asthma (43%; OR:7.8; p < 0.05) and with the presence of CRSwNP (38.9%; OR:9.05; p < 0.001). Patients with severe asthma and CRSwNP had high symptom score and exacerbation rate, and reported loss of smell (83%, p < 0.001), were mainly non-atopic (p < 0.001), older (p < 0.001), had late onset asthma, and showed higher FeNO levels (p < 0.001). Sinus CT scores (p < 0.001) correlated with poor asthma control. Multiple logistic regression analysis showed that CRSwNP, AIA and late onset asthma were independently associated with severe asthma.
CONCLUSION: Severe asthma with CRSwNP may represent the most “severe phenotype” of asthma being associated with non-atopic, late onset asthma and AIA. These clinical findings suggests that asthma with nasal polyps may be due to a distinct underlying mechanism or “endotype”.
- © 2014 ERS
