Anju Tripathi Peters

Objective: To evaluate whether treatment responses to the exhalation delivery system with fluticasone (EDS‐FLU; XHANCE®) differ between patients with CRS with nasal polyps (CRSwNP) and patients without nasal polyps (CRSsNP). Study Design: Post hoc analysis of the ReOpen clinical trials conducted between November 2018 and November 2021 for a 24‐week duration. Setting: Multinational, multicenter, randomized, EDS‐placebo‐controlled studies. Methods: Data were pooled from the randomized trials in which patients with CRSwNP (n = 206) or CRSsNP (n = 341) were randomly assigned (1:1:1) to EDS‐FLU 186 μg, 372 μg, or EDS‐placebo, 1 or 2 sprays twice daily per nostril for 24 weeks. Endpoints included composite symptom score, Smell Identification Test (SIT), sinus opacification on computed tomography (CT) scan, frequency of acute exacerbations of CRS, 22‐Item Sino‐Nasal Outcome Test (SNOT‐22), and Patient Global Impression of Change (PGIC). Results: Patients with CRSwNP and CRSsNP reported substantially greater benefits with EDS‐FLU versus EDS‐placebo on symptoms, SIT, sinus opacification on CT scan, incidence of acute exacerbations of CRS, and quality‐of‐life outcomes (SNOT‐22 and PGIC). Composite symptom score and SNOT‐22 improvements were consistent in the subgroup of patients entering the trial reporting symptoms despite recent standard‐delivery nasal steroid spray use. Treatment‐by‐subgroup interaction effects indicated similar magnitude EDS‐FLU treatment effect for patients with CRSwNP and patients with CRSsNP. Conclusion: EDS‐FLU improved subjective and objective measures of CRS irrespective of nasal polyp status. Trial Registration: Title: Study Evaluating the Efficacy and Safety of Intranasal Administration of OPN‐375 in Subjects With Chronic Rhinosinusitis With or Without the Presence of Nasal Polyps; ID: NCT03781804 and NCT03960580, Clinicaltrials.gov.

The therapeutic goal in chronic airway diseases is shifting from symptom control to disease remission. Disease‐modifying therapies, including biologics and allergen immunotherapy, have made remission achievable in patients with severe asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), or allergic rhinitis (AR). This EUFOREA consensus aims to establish practical guidance for inducing and maintaining remission in global airway diseases. An international panel of experts in pneumology, rhinology, and allergology convened in Rome (October 2025) to review current evidence and develop consensus statements. The panel achieved consensus on key principles: (i) remission is a therapeutic target independent of disease severity prior to treatment initiation and should not be reserved for severe cases; (ii) CRSwNP with nonallergic eosinophilic asthma, and AR with allergic asthma should be considered features of a single disease rather than comorbidities; (iii) remission should be assessed by each subspecialty separately while warranting combined approaches; (iv) pragmatic definitions prioritizing achievability and clinical utility are recommended; and (v) a 4‐week recall window is preferred to assess symptom control within the evaluation of remission and a 12‐month period is suggested as the minimal period to define remission. Remission represents an ambitious yet achievable goal, with practical guidance for optimizing patient outcomes.

Introduction Coexisting type 2 inflammatory diseases such as allergic rhinitis (AR), atopic dermatitis (AD), chronic rhinosinusitis (CRS) and/or nasal polyposis (NP), eosinophilic esophagitis (EoE), and urticaria are common in asthma. RAPID (NCT04287621), a global prospective registry, aimed to characterize patients with asthma initiating dupilumab in a real-world clinical setting. This analysis investigated the prevalence of coexisting type 2 inflammatory diseases in these patients. Methods Patients aged ≥ 12 years initiating dupilumab for asthma (primary indication) according to country-specific prescribing information were enrolled in RAPID. Patients had regular assessments at 1 month and thereafter every 3 months for up to 3 years, per standard of care across study sites. Results At the time of analysis, 205 patients were enrolled. Mean age of patients (stratified by type 2 coexisting disease) ranged from 42.3 to 57.3 years and mean body mass index from 29.9 to 31.8 kg/m². Most patients were female (67.3% to 77.4%), and mean time since asthma diagnosis was 17.3 to 24.0 years, with mean duration of coexisting diseases ranging from 9.8 to 17.0 years. A total of 189 (92%) patients had ≥ 1 ongoing type 2 coexisting disease (AR, 80%; CRS and/or NP, 45% [CRS with NP, 47%; CRS without NP, 41%; NP, 12%]; AD, 27%; urticaria, 15%; and EoE, 3%). Conclusion This analysis from the RAPID registry shows that type 2 coexisting diseases are highly prevalent in patients with asthma initiating dupilumab in a clinical practice setting and highlights the importance of properly assessing patients to improve patient care. Trial Registration ClinicalTrials.gov: NCT04287621.

Background: Loss of smell is a principal symptom of chronic rhinosinusitis with nasal polyps (CRSwNP), affecting health‐related quality of life and posing a safety hazard. Methods: WAYPOINT (NCT04851964), a phase 3, multicenter trial in adults with uncontrolled CRSwNP, randomized patients 1:1 to receive tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. Changes from baseline in biweekly mean Nasal Polyposis Symptom Diary (NPSD) loss of smell item, University of Pennsylvania Smell Identification Test (UPSIT), and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) loss of smell/taste item scores, as well as anosmia (UPSIT score ≤18) prevalence, were assessed over 52 weeks. Results: Among 408 patients (tezepelumab [ n = 203]; placebo [ n = 205]), significant improvements with tezepelumab versus placebo in NPSD loss of smell item, UPSIT, and SNOT‐22 loss of smell/taste item scores were seen at week 4 (least‐squares mean [LSM] treatment difference [95% CI]: −0.36 [−0.46, −0.27]; 6.03 [4.72, 7.34]; and −1.01 [−1.22, −0.80], respectively) and week 52 (−1.01 [−1.18, −0.83]; 9.50 [7.84, 11.16]; and −1.90 [−2.20, −1.61]); all nominal p  < 0.0001. Between‐treatment differences in daily NPSD loss of smell item score were evident from day 7 (LSM treatment difference: −0.08 [95% CI: −0.15, −0.02]; nominal p  < 0.01). Improvements in NPSD loss of smell, UPSIT, and SNOT‐22 loss of smell/taste item scores were observed across multiple prespecified subgroups. Anosmia prevalence was lower with tezepelumab than placebo at week 4 (43.0% [ n/N = 64/149] vs. 80.3% [ n/N = 106/132]) and week 52 (31.5% [ n/N = 47/149] vs. 75.8% [ n/N = 100/132]). Conclusions: Tezepelumab provides early and sustained improvements in sense of smell among patients with uncontrolled CRSwNP.

Background: Precedent chronic rhinosinusitis (CRS) is associated with new‐onset asthma and non‐cystic fibrosis bronchiectasis (BE). Objective: To assess if endoscopic sinus surgery (ESS) mitigates the development of lower airway diseases in patients with CRS. Methods: This retrospective study utilized electronic medical records from an academic center. CRS patients ( > 18 years old) without asthma or BE, were identified between January 2006 and December 2013. Charts were reviewed until May 2023. New diagnoses of asthma or BE were identified in patient records following ESS before December 2018 compared to patients without ESS. Lund–Mackay (LM) scores were calculated in a random subset of patients to assess disease severity. Logistic regression was used to estimate the odds of developing asthma or BE by ESS status. Results: A total of 1877 patients underwent ESS, while 13,453 did not. CRS severity was higher in the ESS group (LM, 9.02) versus no ESS group (LM, 4.28). After up to 17 years of follow‐up, 207/1877 (11%) and 40/1877 (2.1%) of patients with ESS had a new asthma or BE diagnosis, respectively. Out of 13,453 patients, 1778 (13.2%) and 293 (2.2%) patients without ESS had a new asthma or BE diagnosis. The unadjusted odds of a new asthma diagnosis were lower by 19% for ESS versus no ESS; OR (95% CI), 0.81 (0.70–0.95). After controlling for confounders (age, gender, race/ethnicity, smoking status, and chronic rhinitis), the association remained significant, with a 15% reduction in the odds of a new asthma diagnosis; OR (95% CI), 0.85 (0.73–0.99). There was no association between ESS status and a new diagnosis of BE. Conclusions: Despite higher CRS severity, patients undergoing ESS had a lower risk of a new asthma diagnosis and did not have a higher risk of developing BE.