%0 Journal Article
%T Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study.
%A Blanco-Aparicio M
%A Domínguez-Ortega J
%A Cisneros C
%A Colás C
%A Casas F
%A Del Cuvillo A
%A Alobid I
%A Quirce S
%A Mullol J
%J Allergy Asthma Clin Immunol
%V 19
%N 1
%D 2023 Apr 23
%M 37088840
暂无%R 10.1186/s13223-023-00780-9
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.