Asthma patients, particularly those with severe or difficult to
manage asthma, often have concomitant sinusitis. In some
studies as many as 65% of severe asthmatics have been found
to have evidence of RS on CT. Other observations suggest
a nearly universal incidence of sinusitis in patients with severe
asthma. The evaluation of moderate to severe asthma should
routinely involve a careful review for possible sinusitis, as treating
the sinuses may ease the severity of asthma remarkably.
About 25% of chronic RS patients develop nasal polyps, which
are inflammatory growths extending from the sinuses into the
nasal cavities. There are several characteristics that distinguish
the chronic RS patient with polyps from those that do not develop
polyps. Managing nasal polyps is complex and involves a balance
between surgery designed to open the ostia and aggressive
medical management with corticosteroids instilled into the nose
and sinuses and judicial use of antibiotics and oral corticosteroids.
Current and Future Needs
It is evident that physicians do not recognize RS because
of the subtlety in identifying the spectrum of symptoms as
RS and distinguishing this condition from upper respiratory
tract infections/colds or other on-going forms of rhinitis.
Better teaching of PCPs, earlier referral to allergists and
otolaryngologists, and more use of rhinoscopies and CT scans
will enhance our recognition of this important disease.
Some leading specialists utilize liquid suspensions of
corticosteroids instilled into the sinuses by lavages in treating
RS. Availability of approved formulations of suspensions of
corticosteroids would help with this treatment choice. As we
try to understand RS better, identification of the characteristics
of patients who develop RS, or who then develop nasal polyps,
will become more evident and allow us to recognize those
patients at higher risk. However, studies of the treatment of
RS need higher priority both from governmental agencies and
from the pharmaceutical industry. As it stands today, very few
medications have been studied or approved for the treatment
of RS or related conditions (such as polyps).
Research Needs
Little is known about why some patients with acute RS develop
persistent inflammation of the sinuses that can persist for years
or even a lifetime. Theories about persistent bacterial infections
caused by biofilms, bacterial osteitis, or other conditions need
to be explored and proven, or discredited. The possible role of
Staphylococcus and Streptococcus in chronic RS need to be
explored as does the possible role of chronic fungal infections.
The role of specific immune abnormalities in patients with
recurrent RS needs exploration, as do the immune mechanisms
involved in the normal response to RS. Therapeutic medical
and surgical approaches need careful analysis and long term
assessments.
Unmet Needs
A large percentage of the population has undiagnosed RS, or
inadequately treated RS. Even after establishing the diagnosis,
the appropriate guidelines for medical management have not
been established and there appears to be too much surgery,
performed too early in the course of the disease. Expert
guidelines for the diagnosis and management of RS are needed.
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