Abstract
Background : Chronic rhinosinusitis with nasal polyps (CRSwNP)
is commonly associated with asthma. Treatment of CRSwNP includes
intranasal and systemic corticosteroids, with non-responsive patients
commonly considered for endoscopic sinus surgery (ESS). This nationwide
register-based study evaluated the incidence, prevalence, and treatment
burden of CRSwNP in Finland, and their association with the presence and
severity of comorbid asthma.
Methods : Electronic health records of patients diagnosed with
CRSwNP between 1.1.2012-31.12.2018 in Finnish specialty and primary care
were included in the study. The patients were divided into subgroups
based on presence, severity, and control of asthma: no asthma, mild to
moderate asthma, severe controlled asthma, and severe uncontrolled
asthma. A mean cumulative count of ESS was calculated over time per
subgroup.
Results: The prevalence of CRSwNP increased from 602.2 to 856.7
patients per 100 000 population between years 2012 and 2019 (p
< 0.001). A total of 18 563 patients (59.9% male) had
incident CRSwNP between 2012 and 2019, with 27% having asthma, 6%
having severe asthma, and 1.5% having severe uncontrolled asthma. In
the no asthma, severe controlled asthma, and severe uncontrolled asthma
subgroups, systemic corticosteroids were used by 54.1%, 94.9% and
99.3% (p < 0.001), respectively, while the ESS count three
years post diagnosis was 0.49, 0.68 and 0.80, respectively.
Conclusions: The prevalence of CRSwNP showed a significant
increase in the recent decade in Finland. Comorbid asthma, and in
particular severe asthma, increased the probability of receiving
systemic corticosteroids and undergoing ESS. Thus, improved management
of CRSwNP in patients with comorbid asthma is urgently needed.
Key words : Asthma, comorbidity, CRSwNP, endoscopic sinus
surgery, nasal polyps