Clinical Toolkit

Introduction

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory disease of the nasal mucosa and paranasal sinuses that is associated with significant morbidity and reduced health-related quality of life.1

Approximately 2.1% of the United States (US) population is estimated to have chronic rhinosinusitis (CRS), and about 20–30% of those patients with CRS have nasal polyps.1 However, prevalence estimates for nasal polyps based on questionnaires may not represent an accurate estimate, since nasal endoscopy is required to make a reliable diagnosis.1-4 The estimated annual economic burden in the US is ~$22 billion for direct and indirect costs for CRS (2014) and $5.7 billion for CRSwNP (2019).5,6

While females are less likely than males to be affected by CRSwNP, they are more likely to experience severe symptoms.1,7 Generally, it is a disease of middle age, with the highest incidence in the fourth and fifth decades of life.1 Unfortunately, many patients with CRSwNP do not seek medical attention for sinonasal symptoms, which often develop slowly over time. As a result, many patients diagnosed in middle age may have had severe disease with symptoms for years or even decades.1

It is imperative that clinicians have up-to-date knowledge about CRSwNP and its treatments. We invite you to explore the rest of this clinical toolkit. In it, you will find information on pathophysiology, diagnosis, current and emerging treatments, and additional resources to help you improve your practice.
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References

  1. Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of disease in chronic rhinosinusitis with nasal polyps. J Asthma Allergy. 2021;14:127-134.
  2. Bhattacharyya N, Gilani S. Prevalence of potential adult chronic rhinosinusitis symptoms in the United States. Otolaryngol Head Neck Surg. 2018;159:522-525.
  3. Hedman J, Kaprio J, Poussa T, Nieminen MM. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol. 1999;28:717-722.
  4. Klossek JM, Neukirch F, Pribil C, et al. Prevalence of nasal polyposis in France: a cross-sectional, case-control study. Allergy. 2005;60:233-237.
  5. Smith KA, Orlandi RR, Rudmik L. Cost of adult chronic rhinosinusitis: a systematic review. Laryngoscope. 2015;125:1547-1556.
  6. Bhattacharyya N, Villeneuve S, Joish VN, et al. Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps. Laryngoscope. 2019;129:1969-1975.
  7. Alobid I, Antón E, Armengot M, et al. SEAIC-SEORL. Consensus document on nasal polyposis. POLINA project. J Investig Allergol Clin Immunol. 2011;21(suppl 1):1-58.

Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX

Copyright © 2020 | CLEAR Initiative | All Rights Reserved | Website by Divigner

CLEAR Initiative

Chronic rhinosinusitis with nasal polyplosis (CRSwNP) is a chronic inflammatory disease of the nasal mucosa and paranasal sinuses that is associated with significant morbidity and reduced quality of life.

The pathophysiology of CRSwNP is associated with local and systemic inflammation, with ongoing symptoms of nasal congestion, rhinorrhea, and loss of smell. These symptoms result in a significant burden on patients.

As one of the most common medical conditions in the US, CRSwNP has a predominately type 2 inflammatory endotype. It is typically treated with medical management consisting of inhaled corticosteroids, oral corticosteroid bursts, and saline irrigation. Leukotriene antagonists and antibiotics are also used, and if medical management fails, surgical intervention is typically chosen. Additionally, biologics that target type 2 inflammation are now available. These have been or will be approved for use in these patients.

Our CLEAR program is an online tool that aims to provide clinicians and patients with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for individuals with CRSwNP. Our goal is to provide information that empowers clinicians and patients to speak openly about treatment decisions and improve the standard of care for patients with this challenging disease.

Thank you for visiting our website. We invite you to explore the Clinician Toolkit and Patient Toolkit links as well as our pages on CME events, a poster portal to create your own poster, links to animated videos, and much more!

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM).
This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.

Copyright © 2019 | CLEAR Initiative | All Rights Reserved | Website by Divigner

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