1. Eosinophilia, asthma, NERD and the use of oral corticosteroids predict uncontrolled chronic rhinosinusitis with nasal polyps after surgery.
- Author
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Penttilä E, Sillanpää S, Vento SI, Myller J, Koskinen A, Hammarén-Malmi S, Laulajainen-Hongisto A, Hytönen M, Lyly A, Lilja M, Kauppi P, Numminen J, Rautiainen M, Sahlman J, Nuutinen M, Toppila-Salmi S, and Virkkula P
- Subjects
- Humans, Adrenal Cortex Hormones adverse effects, Chronic Disease, Anti-Bacterial Agents, Nasal Polyps surgery, Rhinosinusitis, Rhinitis diagnosis, Rhinitis drug therapy, Rhinitis surgery, Eosinophilia etiology, Asthma diagnosis, Asthma drug therapy, Asthma complications
- 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/≥l 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., Conclusions: 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.
- Published
- 2024
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