Abstract
Patients with non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) often suffer from chronic rhinosinusitis (CRS) with nasal polyps, a form of primary diffuse Type 2 CRS. Although this disease is also seen in NSAID-tolerant patients, CRS in N-ERD often is more severe and more treatment resistant; local nasal therapy (nasal corticosteroids) and endoscopic sinus surgery are employed like in NSAID-tolerant patients, but with limited and/or short-lived effects. This mini-review gives an overview of the current additional treatment options for CRS in N-ERD. As such diets, aspirin therapy after desensitization, antileukotriene therapy and biologicals are discussed based on the current body of literature. Selecting the right treatment strategy depends on shared-decision making, local availability and cooperation between ENT-surgeons, allergists, and pulmonologists.
Highlights
Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for more than 12 weeks, and leading to nasal obstruction, rhinorrhea, loss of smell, and/or facial pain/pressure [1]
CRS symptoms are quite bothersome, leading to a significant reduction in health-related quality of life [10], especially when nasal polyps are present (CRSwNP), and even more in those suffering from non-steroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (N-ERD) [11, 12]
This review aims to give an update of the current therapeutic options for the management of CRS in patients with N-ERD
Summary
Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for more than 12 weeks, and leading to nasal obstruction, rhinorrhea, loss of smell, and/or facial pain/pressure [1]. Following the management schemes of EPOS2020 the first line of treatment for primary diffuse CRS is appropriate medical therapy (AMT), consisting of, but not limited to local corticosteroids (either spray, drops, or rinses), saline rinses and/or oral corticosteroids. Those achieving disease controls with AMT should be advised to continue their medication without the need for further investigation or therapy. The additional treatment options for primary diffuse Type 2 CRS are the addition of oral corticosteroids to AMT (if not tried before) or functional endoscopic sinus surgery (FESS). It is pivotal that treating physicians acquaint themselves with the additional treatment options listed below
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