Chronic Rhinosinusitis With Nasal Polyps and Asthma: Understanding the Connection and Treatment Gaps

Chronic rhinosinusitis with nasal polyps increases the likelihood of developing coexisting conditions, such as asthma, underscoring the need for more effective, comprehensive treatments. | Image Credit: Orawan -stock.adobe.com

Chronic rhinosinusitis with nasal polyps (CRSwNP), a type 2 inflammatory disease, significantly increases a patient's likelihood of developing other conditions like asthma, underscoring the interconnected nature of these respiratory ailments and the need for comprehensive treatment strategies, according to a study published in the Journal of Asthma and Allergy.1

Patients who experience CRSwNP may experience facial pressure, absent sense of smell, nasal congestion, runny nose, sore throat, postnasal drip, headaches, snoring, and tooth pain.2 Tobacco smoke, chemicals, allergens like pollen, strong scents, and aspirin or other non-steroidal anti-inflammatory drugs can trigger symptoms.

The presence of coexisting asthma associates with more severe sinus disease, higher rates of corticosteroid dependence, and lower health-related quality of life (HRQOL) with respect to both diseases.1 Patients with CRSwNP and asthma are more prone to sinonasal surgery than those with CRSwNP alone. Furthermore, asthma in these patients is more difficult to control and prone to exacerbations. Coexisting asthma increases the likelihood of sinonasal surgery for patients with CRSwNP. It also makes their asthma harder to control and more susceptible to flare-ups.

First-line therapies like nasal irrigation and topical corticosteroids often inadequately control CRSwNP. Second-line therapies such as oral corticosteroids provide only temporary improvement in HRQOL and reduction in polyp size, and they associate with systemic adverse events when used long-term. An unmet need exists for treatments that effectively improve both clinical markers and associated HRQOL in either or both diseases.

Dupilumab significantly improved both objective and patient-reported outcomes for patients with severe, uncontrolled CRSwNP. Other studies have found dupilumab efficacious in subpopulations of patients with chronic rhinosinusitis with nasal polyps and asthma. During a case reported study, dupilumab use led the patient to experience no acute exacerbation of chronic rhinosinusitis, no adverse symptoms related to dupilumab, the sinusitis symptoms were completely controlled, and the subjective score of smell significantly improved, after the first dose.3

The AROMA study (NCT04959448) focuses on real-world evidence by collecting data on dupilumab's long-term effectiveness, as represented by changes in patient-reported outcomes and HRQOL over time. It also aims to characterize patients who receive dupilumab for CRSwNP in a real-world setting.1 AROMA is a phase 4, prospective, observational, multicenter, global registry study conducted in the US, Canada, Germany, Italy, Japan, and the Netherlands.

By February 2023, the study had enrolled 303 patients, with nearly 70% also having asthma. Patients with both CRSwNP and asthma were slightly older (52.6 vs 46.8 years) and less often male (46.2% vs 57%). Both groups underwent sinonasal surgery at similar rates (62.4% vs 60.2%), averaging 2 prior surgeries for those with asthma compared with 1.7 for those without.

Patients with both diseases had a mean age of asthma diagnosis at 36.6 years. Nearly 29% of patients had at least 1 severe asthma exacerbation in the year before screening. Of these, 8 patients required hospitalization for severe exacerbations, averaging 1.9 days in the hospital. Among all 168 patients screened for asthma, the mean baseline 6-item Asthma Control Questionnaire (ACQ-6) score was 1.4, indicating that 40.5% had poorly controlled asthma (ACQ-6 ≥ 1.5).

Although nasal congestion scores remained consistent across both groups (mean, 1.8 vs 1.8), patients also suffering from asthma experienced slightly worse total symptom scores (mean TSS, 5.5 vs 5.3) and a more pronounced loss of smell (mean LoS, 2.3 vs 2). Researchers found no statistically significant differences between patient groups in patient-reported outcomes.

Patients with coexisting asthma used ongoing leukotriene receptor antagonists more frequently at baseline than those without (41% vs 16.1%). Ongoing oral/systemic corticosteroid use at baseline for either CRSwNP or asthma was similar among patients with coexisting asthma and those without (11% vs 9.7%). Patients with coexisting asthma used intranasal corticosteroids slightly less than those without (34.3% vs 36.6%). Researchers hypothesize that asthma is frequently undiagnosed in patients with CRSwNP, or that a subpopulation of patients lacks an asthma diagnosis despite indicators of lower airway dysfunction.

The relatively small patient sample size limits this analysis, which makes it difficult to draw statistically significant conclusions about disease severity in the 2 subgroups. Additionally, researchers did not collect inhaled corticosteroid and asthma-only medication data. Future analyses will address some of these data gaps about the prevalence of CRSwNP with coexisting asthma and the physiologic connections between the 2 diseases.

“The elevated [fractional exhaled nitric oxide] FeNO levels at baseline, while not in the majority of patients, indicate a high level of airway dysfunction in the AROMA population, supporting the need for a multidisciplinary approach to the treatment of chronic rhinosinusitis with nasal polyps,” study authors concluded.

References

1. Peters AT, Heffler E, Buchheit KM, et al. Comparing baseline characteristics of patients with chronic rhinosinusitis with nasal polyps with and without asthma in the AROMA registry. J Asthma Allergy. 2025;18:1041-1049. doi:10.2147/JAA.S519901
2. What is chronic rhinosinusitis with nasal polyps (CRSwNP)? Allergy & Asthma Network. Accessed July 14, 2025. https://allergyasthmanetwork.org/health-a-z/chronic-rhinosinusitis-with-nasal-polyps-crswnp/
3. Deng M, Fu R, Lv M, Feng Y. Dupilumab for chronic rhinosinusitis with primary nasal polyps: a case report and literature review. J Inflamm Res. 2025;18:4607-4612. doi:10.2147/jir.s513138