Assessment of the rapid effect of dupilumab in two cases of severe asthma comorbid with recurrent eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

Abstract Objective This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis. Method Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not. Results Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01). Conclusion These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis.

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Predictors of disease progression after endoscopic sinus surgery in patients with chronic rhinosinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001245 ◽

2019 ◽

Vol 133 (8) ◽

pp. 678-684 ◽

Cited By ~ 4

Author(s):

K Tsuzuki ◽

K Hashimoto ◽

K Okazaki ◽

H Nishikawa ◽

M Sakagami

Keyword(s):

Disease Progression ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Early Period ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Eosinophilic Chronic Rhinosinusitis ◽

Operative Findings

AbstractObjectiveThis study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.MethodA total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n= 205) and non-eosinophilic chronic rhinosinusitis groups (n= 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses.ResultsThe post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors.ConclusionEarly, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.

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Effects of Endoscopic Sinus Surgery for Eosinophilic Chronic Rhinosinusitis on Respiratory Functions and FeNO Production in the Lower Respiratory Tract

Ear Nose & Throat Journal ◽

10.1177/01455613211032006 ◽

2021 ◽

pp. 014556132110320

Author(s):

Tetsuya Terada ◽

Takaki Inui ◽

Kou Moriyama ◽

Keiki Noro ◽

Yusuke Kikuoka ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Lower Airway ◽

Act Scores ◽

Asthma Control Test ◽

Eosinophilic Chronic Rhinosinusitis ◽

Before And After ◽

The Mean ◽

Asthma Group

Objective: To confirm the relevance of upper and lower airway inflammation in eosinophilic chronic rhinosinusitis (ECRS), the effects of endoscopic sinus surgery (ESS) on lower airway functions and inflammation need to be examined in ECRS patients. Methods: Chronic rhinosinusitis patients with nasal polyps (25 non-ECRS, 28 ECRS) were enrolled. The 12 patients in the ECRS group had comorbid asthma, in contrast to none in the non-ECRS group. We divided ECRS patients into 2 groups of ECRS with and without asthma. Clinical markers, including fraction of exhaled nitric oxide (FeNO), respiratory functions, and the Asthma Control Test (ACT) questionnaire, were investigated before and after ESS. Results: The FeNO levels in the ECRS with asthma group decreased after ESS. The mean FeNO levels in this group were 56.3 ppb before ESS and 24.9, 25.1, 25.0, and 15.5 ppb 1, 2, 3, and 4 months, respectively, after ESS. The mean forced expiratory rates in 1 second before and after ESS were 67.6% and 73.0%, respectively. The mean maximal expiratory flow rates at 50% of the vital capacity before and after ESS were 45.8% and 58.0%, respectively. Significant differences were observed in respiratory functions before and after ESS. The mean ACT scores in the ECRS with asthma group before and after ESS were 17.5 and 23.5, respectively. The ACT scores were significantly higher after than before ESS. Conclusions: The present results indicate that ECRS and bronchial asthma are common eosinophilic airway inflammatory diseases, and ESS for eosinophilic sinusitis may improve lower airway function.

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Omalizumab Restores Response to Corticosteroids in Patients with Eosinophilic Chronic Rhinosinusitis and Severe Asthma

Biomedicines ◽

10.3390/biomedicines9070787 ◽

2021 ◽

Vol 9 (7) ◽

pp. 787

Author(s):

Yoshiki Kobayashi ◽

Akira Kanda ◽

Dan Van Bui ◽

Yasutaka Yun ◽

Linh Manh Nguyen ◽

...

Keyword(s):

Airway Inflammation ◽

Chronic Rhinosinusitis ◽

Severe Asthma ◽

Treatment Effectiveness ◽

Therapeutic Option ◽

Real Life ◽

Sinus Surgery ◽

Global Evaluation ◽

Corticosteroid Resistance ◽

Eosinophilic Chronic Rhinosinusitis

Eosinophilic chronic rhinosinusitis (ECRS), which is a subgroup of chronic rhinosinusitis with nasal polyps, is characterized by eosinophilic airway inflammation extending across both the upper and lower airways. Some severe cases are refractory even after endoscopic sinus surgery, likely because of local steroid insensitivity. Although real-life studies indicate that treatment with omalizumab for severe allergic asthma improves the outcome of coexistent ECRS, the underlying mechanisms of omalizumab in eosinophilic airway inflammation have not been fully elucidated. Twenty-five patients with ECRS and severe asthma who were refractory to conventional treatments and who received omalizumab were evaluated. Nineteen of twenty-five patients were responsive to omalizumab according to physician-assessed global evaluation of treatment effectiveness. In the responders, the levels of peripheral blood eosinophils and fractionated exhaled nitric oxide (a marker of eosinophilic inflammation) and of CCL4 and soluble CD69 (markers of eosinophil activation) were reduced concomitantly with the restoration of corticosteroid sensitivity. Omalizumab restored the eosinophil-peroxidase-mediated PP2A inactivation and steroid insensitivity in BEAS-2B. In addition, the local inflammation simulant model using BEAS-2B cells incubated with diluted serum from each patient confirmed omalizumab’s effects on restoration of corticosteroid sensitivity via PP2A activation; thus, omalizumab could be a promising therapeutic option for refractory eosinophilic airway inflammation with corticosteroid resistance.

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Objective and Subjective Outcomes of the Endoscopic Sinus Surgery for Eosinophilic Chronic Rhinosinusitis

Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology) ◽

10.7248/jjrhi.54.519 ◽

2015 ◽

Vol 54 (4) ◽

pp. 519-525

Author(s):

Kohei Kawamoto ◽

Shigeki Kawamura ◽

Mikiya Asako ◽

Koichi Tomoda

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Eosinophilic Chronic Rhinosinusitis ◽

Subjective Outcomes

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Clinical study on patients with eosinophilic chronic rhinosinusitis undergoing endoscopic sinus surgery

Journal of Japan Society of Immunology & Allergology in Otolaryngology ◽

10.5648/jjiao.32.1 ◽

2014 ◽

Vol 32 (1) ◽

pp. 1-6

Author(s):

Kenzo Tsuzuki ◽

Yusuke Kojima ◽

Yoriko Yukitatsu ◽

Masafumi Sakagami

Keyword(s):

Clinical Study ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Eosinophilic Chronic Rhinosinusitis

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Post-operative course prediction during endoscopic sinus surgery in patients with chronic rhinosinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000543 ◽

2018 ◽

Vol 132 (5) ◽

pp. 408-417 ◽

Cited By ~ 3

Author(s):

K Tsuzuki ◽

K Hashimoto ◽

K Okazaki ◽

M Sakagami

Keyword(s):

Computed Tomography ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Recognition Threshold ◽

Sinus Surgery ◽

Endoscopic Appearance ◽

Eosinophilic Chronic Rhinosinusitis ◽

Superior Meatus ◽

Operative Findings

AbstractObjective:This study aimed to analyse findings of functional endoscopic sinus surgery to estimate the post-operative course of patients with chronic rhinosinusitis.Methods:From 2007 to 2015, 291 adult patients with bilateral chronic rhinosinusitis, divided into eosinophilic chronic rhinosinusitis (n= 210) and non-eosinophilic chronic rhinosinusitis (n= 81) groups, who underwent primary functional endoscopic sinus surgery were enrolled. Functional endoscopic sinus surgery findings, scored as operating score, were analysed in relation to pre-operative olfactory recognition threshold and sinonasal computed tomography imaging score, as well as post-operative endoscopic appearance.Results:Operating scores in eosinophilic chronic rhinosinusitis were significantly worse than those in non-eosinophilic chronic rhinosinusitis. The anterior ethmoid sinus and superior meatus were predominantly inflamed. Operating score significantly correlated with pre-operative olfaction recognition threshold, computed tomography score and pre-operative endoscopic appearance score. In eosinophilic chronic rhinosinusitis, higher operating scores were related to post-operative deterioration of endoscopic appearance score.Conclusion:The operating score reflects the course following functional endoscopic sinus surgery. Patients with more severe operative findings require longer post-operative treatment.

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