Clinical-Cytological-Grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice

  • Matteo Gelardi Department of Otolaryngology, University of Foggia, Italy. https://orcid.org/0000-0003-4406-0008
  • Giuseppe Porro Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy.
  • Vitaliano Quaranta Pulmonology Unit, Ospedale Di Venere, Bari, Italy.
  • Nicola Quaranta Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy.
  • Michele Cassano Department of Otolaryngology, University of Foggia, Italy. https://orcid.org/0000-0002-2293-2832
  • Giorgio Ciprandi | gio.cip@libero.it Allergist consultant, Casa di Cura Villa Montallegro, Genoa, Italy. https://orcid.org/0000-0001-7016-8421
  • *Italian Study Group on CRSwNP

Abstract

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.

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Author Biography

*Italian Study Group on CRSwNP

Luigi Alonzi, Arturo Arnone Caruso, Francesco Barbara, Michele Barbara, Paolo Castelnuovo, Giovanna Ciancio, Andrea Ciofalo, Michele Curatolo, Nicola De Candia, Carlo De Luca, Valentina De Robertis, Valentina Di Benedetto, Valeria Fiore, Lucia Ianuzzi, Clara Imperatore, Cristiano Lingua, Giuseppe Lombardo, Alberto Macchi, Michela Mancini, Alessandro Maselli del Giudice, Patrizia Mola, Mario Notargiacomo, Antonio Palma, Piero Pecoraro, Giuseppe Pellitteri, Krizia Piccininni, Massimo Rinaldi, Valentina Rossi.

Published
2020-06-23
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Section
Pneumology - Original Articles
Keywords:
chronic rhinosinusitis with nasal polyps, asthma, clinical-cytological-grading, cytological phenotype, comorbidity, real-world
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How to Cite
Gelardi, M., Porro, G., Quaranta, V., Quaranta, N., Cassano, M., Ciprandi, G., & Study Group on CRSwNP, *Italian. (2020). Clinical-Cytological-Grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice. Monaldi Archives for Chest Disease, 90(2). https://doi.org/10.4081/monaldi.2020.1277