"Epidemiology of comorbidities and their association with asthma control" (Tomisa, G., Horváth, A., Sánta, B. et al. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol 17, 95 (2021). https://doi.org/10.1186/s13223-021-00598-3 ) is an interesting paper reflecting data collection from more than 12,000 asthmatic patients in Hungary regarding their condition and associated comorbidities. We found it valuable that the paper provides an overview of asthma comorbidities not usually considered in similar reports. Nevertheless, we believe that chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP or CRSsNP) should have been listed due to its high incidence and prevalence, its association with asthma which is also endorsed in both GINA and EPOS, as well as in several peer-reviewed scientific papers, and to reflect the role of this comorbidity in poor control and a most severe presentation of asthma for the patient. Consequently, several targeted therapies (especially monoclonal antibodies) used for several years in severe forms of asthma are now indicated also for the effective treatment of nasal polyps.

Clinical Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven Leuven Belgium

Department Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen Netherlands

Department of Allergy and Rhinology Royal National ENT Hospital London UK

Department of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam The Netherlands

Department of Otorhinolaryngology Head and Neck surgery and Audiology Rigshospitalet Copenhagen University Copenhagen Denmark

Department of Otorhinolaryngology Laboratory of Upper Airways Research University of Ghent Ghent Belgium

Department of Pediatric Respiratory Medicine Immunology and Critical Care Medicine Charité Universitaetsmedizin Berlin Berlin Germany

Department of Pulmonology and Phthisiology Department of Pediatrics Department of Clinical Immunology and Allergology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital in Martin Martin Slovakia

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Division of Immunity and Infection University College London UK

KU Leuven Department of Microbiology and Immunology Allergy and Clinical Immunology Research Unit Leuven Belgium

The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members Brussels Belgium

Zobrazit více v PubMed

Tomisa G, Horváth A, Sánta B, et al. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol. 2021;17:95. doi: 10.1186/s13223-021-00598-3. PubMed DOI PMC

Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: prevalence and risk factors. J Allergy Clin Immunol Pract. 2022;10(6):1395–403. doi: 10.1016/j.jaip.2022.01.016. PubMed DOI

Jarvis D, Newson R, Lotvall J, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012;67:91–8. doi: 10.1111/j.1398-9995.2011.02709.x. PubMed DOI

Fokkens WJ, Lund VJ, Hopkins C et al. Executive summary of EPOS 2020 including integrated care pathways. Rhinology. 2020 Apr 1;58(2):82–111. 10.4193/Rhin20.601. PMID: 32226949. PubMed

De Prins L, Raap U, Mueller T, Schmid-Grendelmeier P, Haase CH, Backer V, Fokkens W, Benoist LB, Prokopakis E, Hopkins C, Claeys N, Teeling T, Cypers L, Cools L, Bjermer LH, Diamant Z, Wahn U, Scadding G, Bachert C, Patel SR, Van Staeyen E, Hellings P. White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA. Front Allergy. 2022 Jun 2;3:889221. 10.3389/falgy.2022.889221. Erratum in: Front Allergy. 2022 Sep 09;3:1001078. PMID: 35769567; PMCID: PMC9234878. PubMed PMC

Claeys N, Teeling MT, Legrand P, Poppe M, Verschueren P, De Prins L, Cools L, Cypers L, Fokkens WJ, Hopkins C, Hellings PW. Patients Unmet Needs in Chronic Rhinosinusitis With Nasal Polyps Care: A Patient Advisory Board Statement of EUFOREA. Front Allergy. 2021 Oct 29;2:761388. 10.3389/falgy.2021.761388. Erratum in: Front Allergy. 2021 Oct 29;2:789425. PMID: 35386961; PMCID: PMC8974789. PubMed PMC

Håkansson K, Thomsen SF, Konge L, Mortensen J, Backer V, von Buchwald C. A comparative and descriptive study of asthma in chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014 Sep-Oct;28(5):383-7. 10.2500/ajra.2014.28.4076. PMID: 25198023. PubMed

Håkansson K, Bachert C, Konge L, Thomsen SF, Pedersen AE, Poulsen SS, Martin-Bertelsen T, Winther O, Backer V, von Buchwald C. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported. PLoS One. 2015 Jul 1;10(7):e0127228. 10.1371/journal.pone.0127228. PMID: 26132710; PMCID: PMC4489400. PubMed PMC

Stjärne P, Odebäck P, Ställberg B, Lundberg J, Olsson P. High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in swedish primary care. Prim Care Resp J. 2012;21:174–9. doi: 10.4104/pcrj.2012.00011. PubMed DOI PMC

Remenschneider AK, Scangas G, Meier JC, et al. EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope. 2015;125:1056–61. doi: 10.1002/lary.25054. PubMed DOI

Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113:104–9. doi: 10.1016/S0194-59989570152-4. PubMed DOI

Teul I, Zbislawski W, Baran S, Czerwinski F, Lorkowski J. Quality of life of patients with diseases of sinuses. J Physiol Pharmacol. 2007;58(Suppl 5):691–7. PubMed

Hellings PW, SWOT Analysis of Chronic Rhinosinusitis Care Anno. 2022. The Journal of Allergy and Clinical Immunology: In Practice. 2022;10(6):1468-71. PubMed

Tomassen P, Vandeplas G, Van Zele T et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137:1449-56.e4. PubMed

Yoo KH, Ahn HR, Park JK, et al. Burden of Respiratory Disease in Korea: an observational study on allergic Rhinitis, Asthma, COPD, and Rhinosinusitis. Allergy Asthma Immunol Res. 2016;8:527–34. doi: 10.4168/aair.2016.8.6.527. PubMed DOI PMC

Yoo KH, Ahn HR, Park JK, et al. Burden of Respiratory Disease in Korea: an observational study on allergic Rhinitis, Asthma, COPD, and Rhinosinusitis. Allergy Asthma Immunol Res. 2016;8:527–34. doi: 10.4168/aair.2016.8.6.527. PubMed DOI PMC

Hellings PW, Prokopakis EP. Global airway disease beyond allergy. Curr Allergy Asthma Rep. 2010;10:143–9. doi: 10.1007/s11882-010-0107-1. PubMed DOI

Giovannini-Chami L, Paquet A, Sanfiorenzo C, Pons N, Cazareth J, Magnone V, Lebrigand K, Chevalier B, Vallauri A, Julia V, Marquette CH, Marcet B, Leroy S, Barbry P. The “one airway, one disease” concept in light of Th2 inflammation. Eur Respir J. 2018 Oct 25;52(4):1800437. 10.1183/13993003.00437-2018. PMID: 30190271. PubMed

Fokkens W, Reitsma S. Unified Airway Disease: a contemporary review and introduction. Otolaryngol Clin North Am. 2023;56(1):1–10. doi: 10.1016/j.otc.2022.09.001. PubMed DOI

Philpott CM, Erskine S, Hopkins C, et al. Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study. Respir Res. 2018;19:129. doi: 10.1186/s12931-018-0823-y. PubMed DOI PMC

Ostovar A, Fokkens WJ, Vahdat K, Raeisi A, Mallahzadeh A, Farrokhi S. Epidemiology of chronic rhinosinusitis in Bushehr, southwestern region of Iran: a GA2LEN study. Rhinology. 2019;57:43–8. doi: 10.4193/Rhin18.061. PubMed DOI

Massoth L, Anderson C, McKinney KA. Asthma and chronic Rhinosinusitis: diagnosis and Medical Management. Med Sci (Basel) 2019;7. PubMed PMC

Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017 Oct;140(4):950–8. 10.1016/j.jaci.2017.03.050. Epub 2017 Jun 8. PMID: 28602936. PubMed

De Greve G, Hellings PW, Fokkens WJ, Pugin B, Steelant B, Seys SF. Endotype-driven treatment in chronic upper airway diseases. Clin Transl Allergy. 2017;7:22. doi: 10.1186/s13601-017-0157-8. PubMed DOI PMC

Hens G, Vanaudenaerde BM, Bullens DM, et al. Sinonasal pathology in nonallergic asthma and COPD: ‘united airway disease’ beyond the scope of allergy. Allergy. 2008;63:261–7. doi: 10.1111/j.1398-9995.2007.01545.x. PubMed DOI

Braunstahl GJ, Fokkens WJ, Overbeek SE, KleinJan A, Hoogsteden HC, Prins JB. Mucosal and systemic inflammatory changes in allergic rhinitis and asthma: a comparison between upper and lower airways. Clin Exp Allergy. 2003 May;33(5):579 – 87. 10.1046/j.1365-2222.2003.01652.x. PMID: 12752585. PubMed

Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet. 2019;394:1638–50. doi: 10.1016/S0140-6736(19)31881-1. PubMed DOI

Weinstein SF, Katial RK, Bardin P et al. Effects of Reslizumab on Asthma Outcomes in a subgroup of eosinophilic asthma patients with self-reported chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract 2019;7:589 – 96.e3. PubMed

Tiotiu A, Oster JP, Roux P, et al. Omalizumab’s effectiveness in severe allergic asthma and nasal polyps: a real-life study. J Investig Allergol Clin Immunol. 2019 doi: 10.18176/jiaci.0391:0. PubMed DOI

Ostovar A, Fokkens WJ, Vahdat K, Raeisi A, Mallahzadeh A, Farrokhi S. Epidemiology of chronic rhinosinusitis in Bushehr, southwestern region of Iran: a GA2LEN study. Rhinology. 2019;57:43–8. doi: 10.4193/Rhin18.061. PubMed DOI

Striz I, Golebski K, Strizova Z, Loukides L, Bakakos P, Hanania NA, Jesenak M, Diamant Z. New Insights into the pathophysiology and therapeutic targets of Asthma and Comorbid Chronic Rhinosinusitis with or without nasal polyposis. Clin Sci. 2023 doi: 10.1042/cs20190281. PubMed DOI PMC

Bel E, ten Brinke A. A rational approach to the management of severe refractory asthma. Treat Respir Med. 2005;4(6):365 – 79. 10.2165/00151829-200504060-00002. PMID: 16336023. PubMed

Ten Brinke A, Grootendorst DC, Schmidt JT, De Bruïne FT, van Buchem MA, Sterk PJ, Rabe KF, Bel EH. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol. 2002 Apr;109(4):621-6. 10.1067/mai.2002.122458. PMID: 11941310. PubMed

Hamilos DL. Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol. 2011 Oct;128(4):693–707; quiz 708-9. 10.1016/j.jaci.2011.08.004. Epub 2011 Sep 3. PMID: 21890184. PubMed

Aarab R, Vijverberg SJH, Prins M, et al. Prevalence of and factors associated with adult-onset asthma in different ethnic groups: the HELIUS study. Respir Med. 2019;150:113–9. doi: 10.1016/j.rmed.2019.02.018. PubMed DOI

Grossman NL, Ortega VE, King TS, et al. Exacerbation-prone asthma in the context of race and ancestry in Asthma Clinical Research Network trials. J Allergy Clin Immunol. 2019;144:1524–33. doi: 10.1016/j.jaci.2019.08.033. PubMed DOI PMC

Chen YT, Chien CY, Tai SY, Huang CM, Lee CT. Asthma associated with chronic rhinosinusitis: a population-based study. Int Forum Allergy Rhinol. 2016;6:1284–93. doi: 10.1002/alr.21813. PubMed DOI

Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinology. 2013;3:788–94. doi: 10.1002/alr.21182. PubMed DOI

Vashishta R, Soler ZM, Nguyen SA, Schlosser RJ. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinology. 2013;3:788–94. doi: 10.1002/alr.21182. PubMed DOI