Published online: October 31, 2017
Clinically, nasal polyps and comorbid asthma (NPcA) is a severe subtype of airway disease that tends to be refractory to conventional medical and surgical treatment. As a special form of united airway disease, NPcA is not well recognized in patients with nasal polyps or asthma. After evaluation of bronchial hyperresponsiveness (BHR) in adult patients with nasal polyps, about 28% to 40% patients with nasal polyps have newly diagnosed asthma. In addition, approximately 19% to 39% patients with adult-onset asthma have nasal polyps. During the natural evolution of this disease combination, a clinical history of nasal polyps usually precedes asthma, and up to 45% of patients with nasal polyps will develop adult-onset asthma. However, the clinical phenotypes of NPcA are poorly understood.
In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Wu and colleagues explore the clinical phenotypes of NPcA through clustering patients based on parameters regarding natural courses and demographic characteristics. Clinical, functional, and inflammatory parameters in both upper and lower airways were also evaluated.
A total of 110 participants with NPcA were recruited from Rhinological Clinics and Respiratory Clinics. Results showed that there were three distinct clusters with respect to disease history, inflammatory status and disease severity: cluster 1 (n = 16, 14.6%, atopic NPcA) was predominantly atopic patients with child-onset airway symptoms, intermediate disease duration, history of family asthma, better lung function, and less severe asthma; cluster 2 (n = 32, 29.1%, smoking NPcA) was characterized by more smokers, short disease duration, adult-onset airway symptoms, less atopy, nonsteroidal anti-inflammatory drug sensitivity, prior sinus surgery history, eosinophilic airway phenotypes, worse lung function, and severe computed tomography appearance; and cluster 3 (n = 62, 56.4%, older NPcA) consisted mostly of older patients with long disease duration, adult-onset airway symptoms, less atopy, more non-eosinophilic airway phenotypes, and prior sinus surgery history.
The inflammatory status and disease severity were markedly different among atopic, smoking, and older NPcA clusters, which further supported the clinical significance of the findings. Identification of these clusters should help clinicians better recognize the clinical characteristics and natural history of their patients with NPcA.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.