A real-world assessment of asthma with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRS has been reported to be a comorbidity of asthma. Objective The current study aimed to investigate the role of CRS in asthmatic outpatients visited in a real-world setting. METHODS: This cross-sectional study enrolled 499 consecutive asthmatic outpatients. Age, sex, BMI, smoking status, lung function, asthma control test, inflammatory type 2 biomarkers (including FeNO, blood eosinophils, serum total IgE, and allergy), treatment step according to GINA, and comorbidities (OSAS, arterial hypertension, bronchiectasis, diabetes mellitus type 2, osteoporosis) were evaluated. RESULTS: 179 (35.87%) patients had CRS, in particular 93 (18.64%) had CRSsNP and 86 (17.23%) had CRSwNP. Type 2 inflammation (defined by at least 1 positive biomarker) was present in 81.44% patients: FeNO was >30 ppb in 46.9%, blood eosinophils >300 cell/mul in 39.67%, serum total IgE was >100 IU/mL in t51.54%, and allergy in 53.71%. By multivariate analysis, type 2 inflammation and blood eosinophils >300 cell/mul were the main predictors (OR 2.54 and 2.26 respectively) of CRS-asthma association. In particular, CRSwNP comorbidity was predicted by type 2 inflammation (OR 3.4), and blood eosinophils >300 cell/mul (OR 3.0). Smoking had a conflicting outcome. CONCLUSION: The present study confirmed that CRS is frequent asthma comorbidity as concerns more than one-third of asthmatic outpatients. CRSwNP is associated with type 2 inflammation and blood eosinophilia. These outcomes underline that CRSwNPasthma phenotype deserves adequate attention for careful management and optimal identification of the best-tailored therapy.