The burden of Chronic Rhinosinusitis with Nasal Polyps and its relation to Asthma in Finland

In this nationwide register study, we described the incidence, prevalence, and treatment burden of chronic rhinosinusitis with nasal polyps (CRSwNP), and its disease association with asthma from 2012 to 2018 in Finland. Here, a significant increase (from 602 to 857 patients per 100 000) was seen in the prevalence of CRSwNP during the follow-up, with concomitant asthma increasing the risk for systemic corticosteroids and endoscopic sinus surgery (ESS). The study was carried out in collaborative work with AstraZeneca, Medaffcon Oy, and the clinical experts from University of Helsinki and Helsinki University Hospital and Tampere University and Tampere University Hospital.

Chronic rhinosinusitis (CRS) is a common disease that can be categorized into two major subtypes according to its phenotypic appearance: CRS with nasal polyps (CRSwNP) or without nasal polyps. Epidemiological, clinical, and pathophysiological evidence has suggested a strong association between asthma and CRSwNP, with reports showing up to 45% of CRSwNP patients having or developing asthma. In this study, patients were divided into subgroups based on presence of asthma comorbidity and its severity and disease management status. ICD-10 diagnosis codes and Nordic Classification of Surgical Procedures (NCSP) were used to detect patients with CRSwNP, asthma, and ESS.

The study cohort covered altogether 53 119 CRSwNP patients, of which 18 563 were newly diagnosed patients. CRSwNP patients were more frequently male (59.9%) and their median age at the time of diagnosis was 53 years. A continuous increase in lifetime prevalence of CRSwNP from 602.2 to 856.7 patients per 100 000 was observed, with the highest incidence seen among patients aged 50-59 and 60-69 years. During the follow-up period, 46.7% of the incident patients had undergone ESS to treat the polyps, with a large fraction of the patients (40.6%, 95% CI: 39.9 – 41.3%) having an ESS during the first year after the diagnosis of polyps. Approximately a quarter (27.0%) of the patients were diagnosed with asthma. Further, asthma, and especially more severe asthma, was associated with significantly greater need for systemic corticosteroids and more frequent sinus surgeries.

The study demonstrated that CRSwNP is a prevalent and increasing health problem with frequent need for treatments with potentially severe side effects. The study also confirmed a strong association between the severity of comorbid asthma and the risk of systemic corticosteroid treatment and earlier and repeated ESS. This shows an urgent need for improved management of CRSwNP in patients with comorbid asthma.

Reference

The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland. Toppila-Salmi S, Hällfors J, Aakko J, Mannerström B, Nieminen K, Telg G, Lehtimäki L. Clinical and Translational Allergy (2022)