Xu Xinni, Reitsma Sietze, Wang De Yun, Fokkens Wytske J
Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.
Allergy. 2021 Nov;76(11):3349-3358. doi: 10.1111/all.14892. Epub 2021 Jun 9.
Chronic rhinosinusitis (CRS) is a complex upper airway inflammatory disease with a broad spectrum of clinical variants. As our understanding of the disease pathophysiology evolves, so too does our philosophy towards the approach and management of CRS. Endotyping is gaining favour over phenotype-based classifications, owing to its potential in prognosticating disease severity and delivering precision treatment. Endotyping is especially useful in challenging CRS with nasal polyposis cases, for whom novel treatment options such as biologicals are now available. The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) reflects these changes with updated rhinosinusitis classifications and new integrated care pathways. With the coronavirus disease 2019 (COVID-19) pandemic, physicians and rhinologists have to balance the responsibility of managing their patients' upper airway while adequately protecting themselves from droplet and aerosol transmission. This review summarises the key updates from EPOS2020, endotype-based classification and biomarkers. The role of biologicals in CRS and the lessons we can draw from their use in severe asthma will be examined. Finally, the principles of CRS management during COVID-19 will also be discussed.
慢性鼻-鼻窦炎（CRS）是一种复杂的上气道炎症性疾病，有广泛的临床变异型。随着我们对该疾病病理生理学的理解不断发展，我们对CRS的治疗方法和管理理念也在不断变化。由于内型分类法在预测疾病严重程度和提供精准治疗方面具有潜力，它正比基于表型的分类法更受青睐。内型分类法在伴有鼻息肉的疑难CRS病例中尤其有用，现在针对这类病例有了如生物制剂等新的治疗选择。最新的欧洲鼻窦炎和鼻息肉立场文件（EPOS2020）通过更新鼻窦炎分类和新的综合护理途径反映了这些变化。随着2019冠状病毒病（COVID-19）大流行，内科医生和鼻科医生必须在妥善管理患者上气道的责任与充分保护自己免受飞沫和气溶胶传播之间取得平衡。本综述总结了EPOS2020的关键更新内容、基于内型的分类法和生物标志物。将探讨生物制剂在CRS中的作用以及我们可以从其在重度哮喘治疗中的应用中吸取的经验教训。最后，还将讨论COVID-19期间CRS的管理原则。
