The prevalence and burden of nasal polyps
Published: July 12, 2021
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a major health problem which causes a significant burden on quality of life and has a huge economic impact. Current estimates of prevalence of nasal polyposis in western settings have mostly relied on patient questionnaires and do not include the gold standard of nasal endoscopy for diagnosis. Until recently, the only treatments for this condition focused on reducing the size of nasal polyps through steroids or surgery. However, in the last decade, a number of targeted antibody therapies have been developed that, due to their mechanism of action, have the potential to substantially improve disease burden and quality of life in patients with CRSwNP. However, these treatments have high financial costs and are currently reserved for severely affected patients who are refractory to standard therapies. Additionally, no study to date has looked at the number of patients that would be eligible for the new biological treatments based on recently published guidelines.
In a retrospective population-based study published in The Journal of Allergy and Clinical Immunology: In Practice by Campion et al., the prevalence of nasal polyps in an Austrian community-based population where more than 10,000 patients underwent endoscopic examination of their nose was investigated. In all patients, data on their demographics and current ENT symptoms were extracted. Patients with endoscopically confirmed nasal polyps had their polyps graded according to the Gevaert system. In addition, further data on their allergy status, asthma status, and chronic rhinosinusitis symptoms were collected. Patients also filled out the sinonasal outcome score German adapted version 20 (SNOT-GAV20) questionnaire. Finally, patients with confirmed polyps were assessed for their eligibility for biological therapy based on an adapted version of the newly published European guidelines (EPOS 2020).
The adjusted prevalence of nasal polyps in this central European population was found to be 1.95%. Furthermore, the majority of polyps were small with 72.5% of patients having a total polyp score of ≤4 (maximum possible score = 8). In line with this finding analysis of the SNOT-GAV20 score found that 67% of patients with nasal polyps had a low symptom burden (score ≤36). Interestingly, 24.8% of patients were found to have clinically “silent” polyps in that they did not meet the current diagnostic criteria for CRSwNP and had no wish for treatment. When this patient group are accounted for, it can be estimated that only 1.2% of the population suffer from clinically relevant nasal polyps. After adapting the currently available guidelines on the use of biologics in nasal polyps it was found that between 6 and 13% of patients with nasal polyps would be eligible for biological therapy. This study is the first to highlight that in a community-based population a significant proportion of nasal polyps are asymptomatic and do not require treatment. It is also the first to estimate the number of patients who would, according to current guidelines, be eligible for newly available biological therapies.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.