Position Paper - Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)

pdfASCIA HP Position Paper CRSwNP 2021735.26 KB

pdfASCIA HP CRSwNP Treatment Algorithm 202195.87 KB


Chronic Rhinosinusitis (CRS) is one of the most common chronic conditions worldwide. CRS is generally subclassified into two dominant subgroups:

  • CRS with Nasal Polyps (CRSwNP), and
  • RS sine (without) NP (CRSsNP).

CRSwNP is a Type 2 (T2) inflammatory disorder and has a significant impact on quality of life which is further reduced if other atopic diseases and asthma are also present.

The health-economic impact is significant, with direct costs to the US health care system regarding the care of CRS patients being more than 10 billion dollars yearly. Indirect costs from absenteeism and decreased productivity are additional and considerable.

Diagnosis of CRSwNP is based on symptoms and endoscopic or computed tomography (CT) scan findings. Patients with a higher number of symptoms (four or more) are more likely to have positive findings of CRS on CT scans.

Despite CRS's significant incidence and quality of life implications, there are relatively few large and well-conducted studies of current first-line therapies. Intranasal corticosteroids (INCS) and saline irrigation are safe and effective for long term use in patients with CRS. Many patients remain suboptimally controlled and require surgical management.

As new medical therapies are becoming available, we need a rational approach to appropriate, equitable, and cost-effective treatment. This position paper aims to provide an overview of this clinical entity and provide a framework for modern management that incorporates newer biological therapies.

This Position Paper was developed by the Australasian Society of Clinical Immunolgy and Allergy (ASCIA) and the Australian Society of Otolaryngology Head & Neck Surgery (ASOHNS) Working Party, comprising: A/Prof Raewyn Campbell, Prof Richard Harvey, Prof Connie Katelaris AM (Chair), Prof Michaela Lucas, Dr Kathryn Patchett, A/Prof Janet Rimmer, Prof Ray Sacks

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