Chronic Polypous Rhinosinusitis Research Articles

Clinical efficacy and mechanism-of-action of recombinant IFNα-2b, and IFNα-2b in combination with γ-D-glutamyl-L-tryptophan, in chronic polypous rhinosinusitis with comorbid bronchial asthma

Clinical efficacy and mechanism-of-action of recombinant IFNα-2b, and IFNα-2b in combination with γ-D-glutamyl-L-tryptophan, in chronic polypous rhinosinusitis with comorbid bronchial asthma

PHENOTYPICAL CHARACTERISTIC OF CHRONIC POLYPOSIS RHINOSINUSITIS

Chronic polypous rhinosinusitis is a multifactorial disease that is accompanied by chronic inflammation of the nasal mucosa and paranasal sinuses with its remodeling, formation and recurrent growth of polyps. Given the unfavorable epidemiological data, as well as frequent relapses of the disease, despite the use of conservative therapy and repeated surgical interventions, this disease significantly reduces the quality of life of patients. This article presents generalized literature data on the clinical phenotypes and endotypes of polyposis rhinosinusitis.

Rhinosinusitis in children with acute respiratory infection: quality of life and features of drug therapy

BACKGROUND: The relevance of the study is due to limited information on the impact of various forms of rhinosinusitis that have arisen against the background of acute respiratory infection on the quality of life of children and effective treatment methods. AIM: To conduct a clinical assessment of the effect on the recovery time and quality of life in children with acute rhinosinusitis and exacerbation of polypous rhinosinusitis that occurred against the background of a respiratory infection, including antiviral drugs in complex treatment in the early stages. MATERIALS AND METHODS: A simple controlled randomized comparative clinical trial was conducted, involving 74 children aged 15 to 18 years. The clinical efficacy and safety of the use of antiviral drugs in complex therapy, which are neuraminidase inhibitors on the 5th, 7th and 10th days of treatment, were evaluated in comparison with groups receiving pentanedioic acid imidazolylethanamide. The inclusion criterion was acute rhinosinusitis and exacerbation of chronic polypous rhinosinusitis against the background of acute respiratory infection. To establish the diagnosis, an examination of ENT organs, computed tomography of the nose and paranasal sinuses were performed, patients subjectively assessed clinical complaints and quality of life in the Russian version of the standard form of the SF-36 questionnaire. RESULTS: Positive dynamics was noted in the early stages in the 2nd subgroup of the 1st group who took neuraminidase inhibitors in addition to complex therapy. Manifested by a decrease in the average score for VAS to 80.0%, difficulty in nasal breathing to 1.7 points on the 10th day of treatment, relative to those taking imidazolylethanamide pentanedioic acid, where there was a decrease in the average score for VAS by 22.4%, difficulty in nasal breathing to 2.54 points. A similar pattern was observed with nasal congestion, rhinorrhea, and quality of life indicators according to the SF-36 questionnaires. CONCLUSION: Improvement of clinical symptoms and quality of life indicators at an earlier date in children with polypous rhinosinusitis and acute rhinosinusitis against the background of a previous respiratory infection with the inclusion of neuraminidase inhibitors in complex therapy confirmed higher efficacy.

Morphological changes in the neuroepithelium of the olfactory zone of the nasal cavity in patients with chronic polypous rhinosinusitis

Morphological changes in the neuroepithelium of the olfactory zone of the nasal cavity in patients with chronic polypous rhinosinusitis

Blood eosinophilia in patients with severe bronchial asthma and chronic polypous rhinosinusitis treated with dupilumab: A review

Bronchial asthma and chronic polypous rhinosinusitis are diseases associated with a T2-inflammatory immune response. These nosologies can be combined, creating the preconditions for a more severe course of multimorbidity, requiring the use of genetic engineering biological therapy. Dupilumab is a monoclonal antibody that can specifically bind to the alpha subunit of the interleukin-4 receptor and block the action of interleukins 4 and 13, which play a key role in the development of T2 inflammation. Numerous studies have demonstrated the high effectiveness of this medicament. The use of dupilumab in some cases may be accompanied by an increase in eosinophils in the blood. This article presents scientific base and our own experience in treating patients with dupilumab-associated eosinophilia, in addition we describe an algorithm for examining this group of patients for the purpose of timely diagnosis of diseases such as eosinophilic granulomatosis with polyangiitis, eosinophilic pneumonia, etc. It should be noted that in the most cases eosinophilia during targeted therapy with dupilumab is temporary and does not cause clinical manifestations.

THE CONTENT OF CYTOKINES REGULATING INFLAMMATION IN NASAL FLUSHING IN CHRONIC RHINOSINUSITIS IN ELDERLY AND SENILE PERSONS

ABSTRACT
 BACKGROUND. Chronic rhinosinusitis is a heterogeneous sinonasal inflammatory disease with constant symptoms and recurrent exacerbations, which affects about 10% of the world's population. Age-related changes in the nasal mucosa (involutive immunodeficiency, atrophic changes, etc.) can affect the course of the inflammatory process, which, in turn, should be borne in mind when planning therapeutic interventions.
 AIMS - to study the features of local production of IL-4, IL-6, IL-8, IL-10 in elderly and senile persons with chronic rhinosinusitis.
 MATERIALS AND METHODS. The study included patients aged 45 to 90 years with a confirmed diagnosis of "chronic rhinosinusitis" in the acute stage, who gave written informed consent to the study. The exclusion criteria were: age up to 45 years; allergic rhinitis; primary immunodeficiency; smoking; oncological disease of any organ system; chronic polypous rhinosinusitis; acute (exacerbation of chronic) diseases of other localization; vaccination; use of immunotropic drugs for 3 months before the start of the study. The scope of the laboratory examination included determination of the concentration of cytokines IL-4, IL-6, IL-8, IL-10 in nasal secretions by enzyme immunoassay.
 RESULTS. The analysis of the determined values showed that the maximum level of IL-4 was determined in younger persons with rhonic rhinosinusitis 45-59 years old compared with older persons. In our study, the maximum content of IL-6 occurred in a group of patients aged 75-90 years, while the cytokine level significantly exceeded IL-6 in a group of healthy age-related patients, which indicates a more pronounced inflammatory reaction in patients of the oldest group with chronic rhinosinusitis. Cytokine levels above 600 pg/ml were found mainly in patients with chronic rhinosinusitis. Patients of group 4 had high IL-10 values and their values went beyond the range of the comparison groups.
 CONCLUSION. The maximum level of macrophage-monocytic cytokines (IL-6 and IL-8) and anti-inflammatory IL-10 is determined in nasal flushing in patients with chronic rhinosinusitis aged 75-90 years, the highest detectable values of IL-4 are characteristic of patients aged 45-59 years.

Clinical observation of the course of eosinophilic otitis media against the background of biological therapy of chronic polypous rhinosinusitis

Clinical observation of the course of eosinophilic otitis media against the background of biological therapy of chronic polypous rhinosinusitis

Some immunological aspects of targeted therapy in polypous rhinosinusitis

Over the past decade, targeted therapy with various monoclonal antibodies has become particularly relevant for the treatment of chronic polypous rhinosinusitis (PR). This is primarily due to the high incidence rate, polyetiological origin and pathogenetic features of polyposis development, low effectiveness of existing treatment approaches, the tendency for relapse, and comorbid conditions. The article provides a brief historical background concerning various predictors of the mucous membrane remodeling in the nasal cavity and paranasal sinuses at the stages of the polyposis formation thus justifying the need for implementation of monoclonal antibodies in the treatment schedules. Considering the leading role of Th2-inflammation in immunopathogenesis of developing polypous vegetations, the influence of targeted therapy upon treatment of chronic polypous rhinosinusitis is theoretically evaluated, and we highlight some important issues that should be further specified. Undoubtedly, inhibition of the synthesis of necessary interleukins leads to improvement in clinical symptoms and reduced size of polypous vegetations. At the same time, the real biochemical transformations of the nasal mucosa have been scarcely studied. E.g., an attempt to inhibit some cytokine may lead to indirect blockage of other pro-inflammatory cytokines. In future, it is necessary to study the pharmacodynamics of targeted drugs in order to clarify distinct contraindications to their use.

Effect of topical drugs on the local concentrations of IL-5 and mometasone furoate in chronic polypous rhinosinusitis

Long-term persistence of inflammation is the main factor of pathogenesis in chronic polypous rhinosinusitis (CRSwNP). Prospectives of current clinical otorhinolaryngology include modification of drugs containing topical glucocorticosteroids in order to increase local bioavailability, reduce the concentration of glucocorticosteroids, and alleviate the local inflammatory response. The aim of our work was to evaluate the effect of urea, magnesium sulfate, and mannitol on the concentrations of mometasone furoate and IL-5 in the polypous tissue of patients with CRSwNP. The study included 146 patients with CRSwNP aged 18 to 62 years. Biopsies of polypous tissue were taken during polypotomy. In the fluid samples obtained by microdialysis of polypous tissues, mometasone concentrations were determined by high-performance liquid chromatography. Concentrations of IL-3, IL-4, IL-5 and IL-10 cytokines in blood serum, and IL-5 in microdialysates of polypous tissue were measured by ELISA technique. The average age of patients with CRSwNP was 42.9±7.2 years, with prevalence of male patients (n = 93, 63.7%) over females (n = 53, 36.3%). Severity parameters of the disease by the SNOT-22 scale were significantly higher in CRSwNP patients than in control group (p ≤ 0.05). The results of biochemical analysis of microdialysates from polypous tissue showed increased content of Na+ ions in the resistant clinical cases of CRSwNP compared with the sensitive and dependent clinical forms (p < 0.05). Curves with the level of mometasone furoate were obtained in all the studied samples. It was found that the addition of magnesium sulfate solution to mometasone increases the Cmax of mometasone to 154 ng/mL in biological fluids after microdialysis. When urea solution is added to mometasone, Cmax increases to 198 ng/mL. In the native nasal polypous tissue dialysate, IL-5 levels were 89±2.01 pg/mL. Two hours after the addition of mometasone furoate, IL-5 concentrations decreased to 61±3.5 pg/mL, upon addition of urea, it changed to to 69±2.98 pg/mL (p ≤ 0.01, compared with the control without the addition of drugs). Analysis of serum cytokine levels showed that IL-5 concentrations in the patients with CRSwNP significantly exceeded (> 3-fold) those in the control group (p ≤ 0.05). There was a trend for increase of IL-3 and IL-4 (2-fold) and to decreased IL-10 levels in blood sera (> 1.5-fold) in patients with CRSwNP compared with controls. These results may be helpful for development of novel clinical approaches, in order to increase bioavailability of topically administered glucocorticosteroids, thus allowing to promote the effectiveness of basic therapy of CRSwNP and to develop therapy for the prevention of resistant forms of polyposis.

Частота генотипа гиполактазии взрослых (первичной лактазной недостаточности) у больных хроническим полипозным риносинуситом

An assumption has been made about the role of lactase deficiency in the pathogenesis of polypous rhinosinusitis in the domestic literature. Objective. A pilot study of the frequency of carriage of the genetic marker of adult hypolactasia of the C/C(-13910) polymorphism of the MCM6 gene in patients with chronic polypous rhinosinusitis; analysis of modern literature data on the prevalence of C/T(-13910) polymorphism of the MCM6 gene in the population of the European part of Russia. Patients and methods. 16 Caucasian patients with chronic rhinosinusitis with nasal polyps (CRSwNP) were examined. The prevalence of the nasal polyposis was assessed on the basis of computed tomography of the paranasal sinuses, the determination of the genetic marker of the C/T(-13910) polymorphism of the MCM6 gene was determined by real-time PCR. Results. Severe course of CRSwNP based on CT data of the paranasal sinuses was established in 69% of cases. Concomitant pathology of the respiratory tract was detected in 75% of patients: a combination of CRSwNP, bronchial asthma (BA), and allergic rhinitis (AR) 31%; CRSwNP and BA 19%; CRSwNP and AR 25% of cases. The CC genotype associated with primary hypolactasia was detected in 37.5% of cases. The genotypes associated with lactase persistence were established: CT in 56.25%, TT in 6.25% of patients. Allele frequency C 0.65, T 0.34. The distribution of genotype frequencies corresponds to the Hardy–Weinberg equilibrium distribution (χ2 test 0.97, Hardy–Weinberg exact equilibrium test p = 0.43). 67% of carriers of the CC genotype in patients with CRSwNP did not have any clinical signs of lactase deficiency. Among 3 patients with CRSwNP who noted intestinal discomfort after eating dairy products, CC genotype was in 2 people (33% of genotype carriers), CT in 1 patient (11% of heterozygotes). Conclusion. The frequency of carriage of the CC genotype of the single nucleotide polymorphism C/T (-13910) of the MCM6 gene associated with low lactase activity in patients with CRSwNP (Saint Petersburg residents) was detected at the level of 37.5%, which does not exceed the prevalence of the primary hypolactasia genotype in the general population of the European part of Russia.

Effect of Dexamethasone and Lidocaine on the Cytokine Profile and Bleeding during Endoscopic Rhinosinus Surgery

The objective: to evaluate the feasibility of using dexamethasone and lidocaine to potentiate the effect of anesthesia in patients with chronic polypous rhinosinusitis during functional endoscopic sinus surgery (FESS) interventions.Subjects and Methods. Clinical data, blood serum samples were collected prospectively from 52 patients who underwent FESS intervention. The patients were divided into 3 groups: Control Group ‒ C (n = 26), anti-inflammatory drugs were not administered; Dexamethasone Group ‒ D (n = 13), dexamethasone was administered (0.10‒0.15 mg/kg); and Lidocaine Group ‒ L (n = 13), a 1% solution of lidocaine was administered intravenously. The following parameters were studied: IL-6, IL-10, IL-18, alpha1-antitrypsin, and ferritin.Results. An increase of IL-6, IL-6/IL-10 was observed in Group C. An increase of IL-10 and a decrease of IL-6, IL-6/IL-10 were noted in Group D. In Group L, IL-6, IL-6/IL-10 did not change significantly. The intensity of bleeding was lower in Groups L (p < 0.001) and D (p < 0.05) versus Group C. Relative changes in the concentration of biomarkers within the normal range were detected in all groups.Conclusions. Changes in the cytokine profile are insignificant in patients with chronic polyposis rhinosinusitis during FESS performed under combined anesthesia.No convincing data on the need for intraoperative use of dexamethasone or intravenous lidocaine have been received.

Three T2 inflammatory diseases in adolescents: asthma, eosinophilic esophagitis, and chronic polypous rhinosinusitis (Clinical Case)

It has long been known that comorbid diseases such as chronic polypous rhinosinusitis and obesity adversely affect the pathophysiology of asthma, impair response to therapy and reduce the quality of life of patients. Identification and effective treatment of comorbidities will improve asthma control and reduce the frequency of exacerbations. There are more and more studies that indicate a close pathophysiological relationship with allergic diseases of eosinophilic esophagitis. According to the latest data in the development of allergic diseases (asthma, allergic rhinitis, atopic dermatitis, food allergy), chronic polypous rhinosinusitis, and eosinophilic esophagitis, the key is the T2 immune response (T2 inflammation) in both children and adults.
 Timely diagnosis of inflammatory states of T2 inflammation can help in choosing the optimal treatment for such patients. Here we describe the comorbid conditions that occur in an adolescent with controlled asthma and discuss the features of their clinical course.
 The purpose of this work is to raise the awareness of practitioners about comorbid diseases — eosinophilic esophagitis and chronic polypous rhinosinusitis in children with bronchial asthma. Each of these comorbid diseases has clear diagnostic criteria, although they are underdiagnosed by medical specialists.

Study of the effectiveness of interferon gamma therapy and evaluation of its effect on the level of cytokines in patients with chronic polypous rhinosinusitis

Background. Chronic polyposis rhinosinusitis is characterized by an immune-dependent type of polyp formation with a defect in local protective factors. The use of local immunomodulators will improve immune protection in the nasal cavity.
 Aim. To study cytokine levels in nasal secretion and blood serum in patients with chronic polyposis rhinosinusitis after therapy with interferon gamma.
 Material and methods. To study immunological indices, 32 patients with chronic polyposis rhinosinusitis, who were treated with intranasal interferon gamma, and 30 healthy people (control group) were examined. In the group of patients with the disease, the levels of interleukins-4, -10 and -18, tumor necrosis factor , and secretory immunoglobulin A were determined in the nasal secretion and blood serum before treatment and 1 month after it. Statistical analysis of the results was performed using the Statistica 12.0 software package. The test for normality of distribution in the sample was carried out using the ShapiroWilk test. Most of the parameters did not have a normal distribution; therefore, nonparametric statistical methods were used for further analysis. The description of the results obtained in the study was carried out by calculating the median (Me) and the interquantile range in the form of the 25th and 75th percentiles (Q0.25 and Q0.75). Comparative analysis of quantitative signs in independent groups was performed according to the MannWhitney test, in dependent groups using the Wilcoxon method. Differences were considered significant at p 0.05.
 Results. Clinical efficacy was assessed according to a 4-point scale: excellent treatment result, good result, satisfactory and unsatisfactory. A good effect of the therapy was 78.1% (25 patients). Unsatisfactory effect was registered in 7 (21.9%) patients. After treatment, a decrease in the content of interleukin-4 (p2=0.000034), interleukin-18 (p2=0.000075), an increase in the level of interleukin-10 (p2=0.033), a decrease in the amount of secretory immunoglobulin A in the nasal secretion (p2=0.0001) took place. The levels of tumor necrosis factor in blood serum were reduced both before treatment compared with the control group (p1=0.005) and after therapy (p2=0.000075).
 Conclusion. An increase in the content of interleukin-10 in the nasal secretion and a decrease in the level of proinflammatory cytokines interleukin-18, tumor necrosis factor and interleukin-4 in the blood serum after treatment with interferon gamma in patients with chronic polyposis rhinosinusitis may indicate a decrease in the activity of immune inflammation in the nasal cavity.

Clinical efficiency of allergen-specific immunotherapy with fungal allergens in patients with chronic polypous rhinosinusitis against the background of fungal sensitization

Fungal flora is one of the causes of inflammatory, including polypous, processes in the nasal cavity. In this regard, studies aimed at reducing the effect of fungal sensitization (FS) on the course of chronic polypous rhinosinusitis (CPRS) are relevant. The objective of the study was to evaluate the effect of various treatment options on the clinical course of the disease in patients with chronic polypous rhinosinusitis against the background of sensitization to fungi. The study included 90 patients with chronic polypous rhinosinusitis in combination with FS. The patients were divided into two groups – the first clinical group (G1) and the second clinical group (G2). G1 patients received allergen-specific immunotherapy (ASIT) according to the scheme. G2 patients received basic treatment. Evaluation of the clinical efficiency of ASIT was made based on complaints, assessment of symptom severity on a visual analog scale (VAS), and rhinoendoscopic examination. The treatment outcomes were evaluated on a 4-point scale, with excellent results (4 points) – complete remission of the disease during the follow-up period (6–12 months); good (3 points) – exacerbation of the disease 1-2 times a year, in mild form and removed by expectant treatment; satisfactory (2 points) – the number of exacerbations did not decrease. The use of ASIT therapy is pathogenetically justified and leads to a significant improvement in the clinical condition of patients with CPRS with FS.

SOME MODERN FEATURES OF THE DISTRIBUTION AND TREATMENT OF CHRONIC POLYPOSIS RHINOSINUSITIS

Chronic polypoid rhinosinusitis (ORS) is a prolonged, recurrent inflammation of the mucous membrane of the paranasal sinuses (SNP) and nasal cavity with the formation of polyps. Since these structures are a single, in the anatomical and physiological sense, complex, the use of the term “rhinosinusitis” is absolutely justified and allows you to more fully understand the mechanisms of the development of the pathological process and justify a competent, comprehensive treatment strategy. The purpose of this review is to study the prevalence and methods of treatment of chronic polypous rhinosinusitis. Thus, conclusion follows that chronic polypous rhinosinusitis is a polyetiological disease that requires a more detailed study. Treatment of this pathology should include surgery followed by the appointment of intranasal corticosteroids.

The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

Features of adherence to treatment of patients with chronic rhinosinusitis with nasal polyps

Generalization of data on the significance and ways to increase adherence to treatment of patients with CPR. Materials of scientific publications included in the Cochrane Library, Russian Science Citation Index, MEDLINE, PubMed information bases were used as a data source. The material was selected based on the following keywords: "chronic rhinosinusitis", "nasal polyps", "intranasal glucocorticosteroids", "adherence to treatment". Despite the fact that inGCSs are one of the main pathogenetically justified methods of treating CPR, their use is limited by many factors, one of which is the level of patient compliance with the treatment regimen. Improving adherence to treatment is one of the important reserves for increasing the effectiveness of drug therapy for chronic polypous rhinosinusitis.

New possibilities of therapy of T2-associated diseases

New opportunities for the treatment of T2-associated diseases in recent years, the number of patients with atopic dermatitis (ATD), having a moderate and severe form of course, has been increasing. According to research, 30% of the world's population suffer from allergic diseases, such as bronchial asthma (BA), ATD, food allergies, anaphylaxis, chronic polypous rhinosinusitis. The development of these diseases is based on the pathophysiological mechanism of T2-mediated immune inflammation, where cytokines IL-4 and IL-13 play a key role. Diseases based on this type of inflammation belong to the group of T2-associated diseases. Thanks to targeted therapy with dupilumab, which affects the main links of pathogenesis, it is possible to effectively cope with the main manifestations of severe and moderate ATD and BA.
 Aim. To evaluate the effectiveness of biological therapy with dupilumab 300 mg subcutaneously for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in a teenager C. (born 2006).
 Materials and methods. The analysis of the medical history of the patient C., born in 2006, who received therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks with the diagnosis Main: ATD, common form, severe course. Secondary diagnosis: BA, persistent course, uncontrolled, moderate severity. Dynamic monitoring of the total blood count with the calculation of the absolute number of eosinophils in peripheral blood was performed. The allergological examination included the determination of specific IgE-AT to 300 allergens using ALEX2 technology. Criteria for the effectiveness of ATD therapy were evaluated on the SCORAD scale in dynamics, an AST test was used for BA, as well as a study of the function of external respiration before treatment and during therapy.
 Results. The study showed high efficacy and safety of biological therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in patient C. (born in 2006). The conducted allergological examination with the help of the ALEX2 Allergochip made it possible to establish the molecular components of the primary causal allergens, predict the course of an allergic disease, and carry out successful elimination measures against food allergens, preserving the maximum set of nutrients in the patient's diet.
 Conclusion. Therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, with manifestations of severe ATD and BA, uncontrolled course leads to clinically significant improvement in the course of diseases, control of symptoms of diseases. ATD shows a decrease in itching of the skin, normalization of sleep, improvement of quality of life. With BA, a significant reduction in exacerbations, normalization of respiratory function indicators, complete control of the disease has been achieved. The targeted biological drug dupilumab has a targeted effect on the key links in the pathogenesis of ATD and BA and reduces the burden of severe diseases. Therefore, the use of dupilumab in ATD and BA contributes to achieving disease control and improving the patient's quality of life.

Possibilities of using combined drugs in the treatment of nasal obstruction syndrome

Introduction. The problem of chronic polypous rhinosinusitis today remains one of the most urgent in otorhinolaryngology. According to the analysis of medical documentation, diseases accompanied by this symptomatology are one of the most common reasons for contacting an otorhinolaryngologist. Despite the many proposed treatment regimens for polyposis rhinosinusitis, the recurrence rate of the disease remains high. Treatment of patients with polyposis rhinosinusitis is one of the most difficult problems of clinical rhinology. Studies of exocrine secretions of patients with chronic rhinosinusitis made it possible to clarify individual links in the pathogenesis of this disease, to identify differential diagnostic signs and pathogenetic similarities of various forms of rhinosinusitis, and to propose a new method of treatment.The purpose of our present study was to assess the effectiveness of the correction of immunopathological conditions occurring in chronic ORS by using a herbal preparation containing in its composition Pelargonium sidophyta extract, which has antiinflammatory, immunomodulatory and antibacterial effects, in complex therapy.Materials and methods. Clinical and laboratory examination and treatment of 54 patients with a diagnosis of chronic polyposis rhinosinusitis were carried out. Among them, 38 were patients with a disease duration of more than 10 years.Results and discussion. It has been shown that the use of a phytopreparation containing in its composition an extract of pelargonium sieve in the complex treatment of patients with chronic polyposis rhinosinusitis allows achieving stable remission and reducing the number of recurrences of the polyposis process.Conclusions. Our clinical experience allows us to recommend in order to prevent recurrences of chronic polypoid rhinosinusitis to carry out surgical intervention

Chronic polypous rhinosinusitis and lung function in the profile of multi-organ pathology in children with cystic fibrosis in the Russian Federation

Chronic rhinosinusitis (CRS), including chronic rhinosinusitis with nasal polyps (CRSwNP), is one of the manifestations of cystic fibrosis (CF). The paranasal sinuses (PNS) are considered as a reservoir of pathogenic microflora and a source of descending infection of the entire respiratory tract. Nevertheless, paranasal sinuses pathology is usually assessed in isolation from both the lower respiratory tract and the entire spectrum of multiple organ damage in CF.Aim. To determine the prevalence of CRSwNP and its correlation with other characteristics of CF in children in Russia.Methods. The study included data of 2216 children from 0 to 18 years old from 81 regions of the Russian Federation from the Registry of patients with cystic fibrosis in the Russian Federation for 2018. Children with an established diagnosis of CRSwNP (n = 599) were compared to those without this condition (n = 1 617). The prevalence was assessed in the subgroups by age, sex, respiratory function, nutritional status, microbiological status, complications, the need for various therapies, and the average duration of inpatient treatment during the year. The statistical analysis included parametric and nonparametric tests.Results. According to the Registry, the average prevalence of CRSwNP among children with CF was 27.03% and tended to increase with age. Children with CRSwNP had statistically significant higher incidence of homozygous F508del mutation, more common intermittent and chronic infection with P. aeruginosa, S. aureus (MSSA and MRSA), cystic fibrosis-associated diabetes mellitus with daily use of insulin, liver damage (as with or without cirrhosis), osteoporosis, a more frequent need for systemic antibacterial and inhalation (except for bronchodilators) therapy, as well as a relatively high need for hospital stay. Unexpectedly, the respiratory function indicators (FEV1, %, FVC, %) and body mass index turned out to be higher in the group of patients with nasal polyposis. A likely explanation is that the study included only children, and the lung function was not analyzed in the children and adolescents.Conclusion. The results suggest that CRSwNP is a predictor of adverse course of CF and requires attention from CF specialists and otorhinolaryngologists, as well as interdisciplinary collaborations.