Chronic polypous rhinosinusitis (CRS)

Spread of the disease

As of August 2020, clinical manifestations of polypous rhinosinusitis occur in 3-5% of the population. In 2010, about 1.5 million people suffered from polypous ^[1]

Causes of polyps

For 2020, there is no clear understanding of the reasons for the appearance of polyps. Among the possible causes contributing to the development and recurrence of the polyposis process, the involvement of allergies, bronchial asthma, chronic inflammatory processes in the paranasal sinuses caused by bacterial flora, viral agents, the influence of various anatomical abnormalities contributing to the violation of aeration and maintaining the inflammatory process, and the presence of genetic predisposition are discussed. About 50% of patients with CRS suffer from asthma, 50-80% of patients also have allergic rhinitis, and about 15% have NPVP-IRZ7, a respiratory disease caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs).

Symptoms

Small polyps in size and number, as a rule, do not cause discomfort and exist asymptomatic, however, large and numerous formations can overlap the nasal passages and thereby lead to problems with nasal breathing.

The main symptoms of chronic sinusitis differ little from those of a common cold:

• constant nasal congestion and runny nose,
• a feeling of swelling and pressure in the area of ​ ​ the face,
• reduced sense of smell and loss of taste.

Despite this, chronic sinusitis differs from the usual cold in the duration of the condition.

Polypous rhinosinusitis has a negative effect on daily life. One of the problems is sleep disturbance due to difficulty breathing, and as a result, a general decrease in mood and rapid fatigue. Symptoms of CRS have an impact on productivity, the ability to enjoy food, drinks and odors. Due to the decrease in smell and loss of taste, a person can not always immediately recognize the potential danger - the smell of smoke, fire or spoiled food. Bronchial asthma, which is difficult to treat, is more common in patients with CRS.

Diagnosis of the disease

The diagnosis of the disease is carried out by an otorhinolaryngologist. It establishes a diagnosis based on symptoms and examination of the nasal passages using special tools. For diagnostic difficulties, the doctor may apply additional research methods, for example, computed tomography, or involve other specialists to clarify the diagnosis. Additional help from an allergist and pulmonologist is usually required to confirm or rule out co-morbidities and to clarify the spectrum of allergens to which hypersensitivity is present.

Treatment

Existing methods of treatment do not always allow you to completely get rid of polyps, but it is possible to reduce the manifestation of symptoms. Therapy for CRS can consist of several steps. To begin with, the doctor may prescribe intranasal corticosteroids, but they are sometimes unable to relieve symptoms in severe forms of the disease. If intranasal corticosteroids have proven ineffective, the physician may prescribe systemic corticosteroids for short courses. Treatment with systemic corticosteroids can increase the risk of undesirable side effects, which is why they are prescribed in short courses. If the therapy prescribed by the doctor does not lead to the necessary result and does not allow controlling the disease, the doctor together with the patient can decide on surgical treatment. According to statistics, half of patients with CRS require surgery due to blockade of the nasal passages by polypous overgrowths and the inability to relieve symptoms.

In 2020, a number of studies of innovative drugs are ongoing that can target the inflammation underlying the disease and give patients hope for a new life without symptoms and repeated surgical interventions.

2025: The drug tezepelumab AstraZeneca and Amgen is registered in Russia for use in polypous rhinosinusitis

The Ministry of Health of Russia has updated the marketing authorization of the drug tezepelumab from AstraZeneca and Amgen and added a new indication for its use - chronic rhinosinusitis with nasal polyps (polypous rhinosinusitis). Previously, the drug was used only for the treatment of bronchial asthma. AstraZeneca announced this on June 10, 2025. Read more here.

2022: Program presented for the treatment of chronic rhinosinusitis

On September 8, 2022, Lyra Therapeutics announced the enrollment of the first patient in a Phase 3 clinical trial of the Enlighten II programm.Read more here.

Notes