Correlation between chronic rhinosinusitis with nasal polyposis (CRSwNP) severity and asthma control

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a predominantly type 2-mediated inflammatory disease with high social and economic burdens. According to the “unified airway diseases theory”, CRSwNP and asthma often occur simultaneously as comorbidities, complicating their overall management. Objective: We aimed to evaluate the correlation between CRSwNP severity, according to the Clinical-Cytological Grading (CCG), and asthma control. Methods: 151 patients suffering from both CRSwNP and asthma step Gina 4–5 were recruited. We examined patients' clinical history and administered to each patient the Asthma Control Test (ACT). Moreover, we performed nasal endoscopy and nasal cytology on all patients. According to nasal cytology findings and comorbidities each patient was assigned a CCG score. Kolmogorov-Smirnov and Shapiro-Wilk tests were performed. A ROC curve was constructed to detect the accuracy of the CCG in detecting not well controlled asthma. Results: The mean ACT was 18.44 ± 4.53. 57 % of patients suffered from not well controlled or poorly controlled asthma. The mean CCG score was 6.68 ± 2.01. 54.3 % of patients had a severe CCG value. Well-controlled asthmatic patients had a lower percentage of severe CCG and a higher percentage of mild CCG. 50 % of patients with non-well or poorly controlled asthma showed a mixed eosinophil-mast cell infiltrate. A CCG <6 and the absence of the simultaneous presence of eosinophils and mast cells in the nasal cytology were associated with well-controlled asthma. Conclusions: Patients with high-grade CCG, especially with mixed eosinophil-mast cell inflammatory infiltrate at nasal cytology, are more prone to uncontrolled asthma.