PDF(Pubmed)
Abstract：
BACKGROUND: Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients.
METHODS: Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median.
RESULTS: A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios.
CONCLUSIONS: We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items.
METHODS: Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median.
RESULTS: A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios.
CONCLUSIONS: We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items.
摘要：
背景：从联合气道疾病（UAD）的角度来看，关于多发性2型哮喘和慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的科学证据仍然很少，尽管这些实体经常共存。我们旨在为UAD患者的管理提供基于专家共识的建议。
方法：使用两轮Delphi方法，西班牙变态反应专家,肺科医师和耳鼻喉科医师对9点李克特量表的32项陈述（52项）表示同意，适当分类(中位数7-9)，不确定(4-6)或不适当(1-3)。当至少三分之二的小组评分在包含中位数的范围内时,考虑共识。
结果：由30名专家组成的小组就52个项目中的43个（82.7％）的适当性达成了共识。某些生物标志物（组织和外周血嗜酸性粒细胞计数，血清总IgE,以及呼出气一氧化氮[FeNO]的分数）在2型炎症的鉴定和随访中，以及对生物制剂反应的评估，都同意了。这些生物标志物中的一些还与内窥镜鼻窦手术（ESS）后的疾病严重程度和/或复发有关。就与抗IL-4/IL-13或抗IgE药物处方相关的治疗策略达成共识，全身性皮质类固醇伴随治疗，结合或转换为具有不同作用机制的生物制剂，考虑到一些UAD临床场景。
结论：我们提供了专家建议，以协助临床决策，以治疗2型哮喘和CRSwNP患者。需要针对单一实体UAD的特定临床试验和现实世界研究来解决有争议的项目。
方法：使用两轮Delphi方法，西班牙变态反应专家,肺科医师和耳鼻喉科医师对9点李克特量表的32项陈述（52项）表示同意，适当分类(中位数7-9)，不确定(4-6)或不适当(1-3)。当至少三分之二的小组评分在包含中位数的范围内时,考虑共识。
结果：由30名专家组成的小组就52个项目中的43个（82.7％）的适当性达成了共识。某些生物标志物（组织和外周血嗜酸性粒细胞计数，血清总IgE,以及呼出气一氧化氮[FeNO]的分数）在2型炎症的鉴定和随访中，以及对生物制剂反应的评估，都同意了。这些生物标志物中的一些还与内窥镜鼻窦手术（ESS）后的疾病严重程度和/或复发有关。就与抗IL-4/IL-13或抗IgE药物处方相关的治疗策略达成共识，全身性皮质类固醇伴随治疗，结合或转换为具有不同作用机制的生物制剂，考虑到一些UAD临床场景。
结论：我们提供了专家建议，以协助临床决策，以治疗2型哮喘和CRSwNP患者。需要针对单一实体UAD的特定临床试验和现实世界研究来解决有争议的项目。
