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- Title
Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study.
- Authors
Blanco-Aparicio, Marina; Domínguez-Ortega, Javier; Cisneros, Carolina; Colás, Carlos; Casas, Francisco; del Cuvillo, Alfonso; Alobid, Isam; Quirce, Santiago; Mullol, Joaquim
- 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. Conclusion: 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.
- Subjects
NASAL tumors; NASAL polyps; AIRWAY (Anatomy); DELPHI method; INFLAMMATION; LIKERT scale; ENDOSCOPIC surgery
- Publication
Allergy, Asthma & Clinical Immunology, 2023, Vol 19, Issue 1, p1
- ISSN
1710-1484
- Publication type
Article
- DOI
10.1186/s13223-023-00780-9