Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, Barcelona, Spain.
Otorhinolaryngology Unit, Hospital Vital Álvarez Buylla, Mieres, Spain.
J Allergy Clin Immunol Pract. 2022 Sep;10(9):2438-2447.e9. doi: 10.1016/j.jaip.2022.04.039. Epub 2022 May 12.
The clinical approach to upper and lower respiratory diseases from a joint perspective, known as united airways disease (UAD), is challenging for health care professionals owing to a paucity of specific studies.
This study reviews recent scientific evidence on the management of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a UAD perspective.
A systematic search of PubMed, Scopus, and Web of Science was conducted for 9 research questions, and studies published from January 2015 to July 2021 were included. Quality assessment was performed with the Critical Appraisal Skills Programme.
In total, 32 publications met the inclusion criteria. Control of type 2 inflammation in UAD (reported in 9 studies) was associated with biologic therapies, for which an impact on asthma, CRSwNP, and/or aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease outcomes was described in 9 studies. However, there was a lack of scientific evidence on clinical and/or biochemical markers associated with response to biologics in patients with UAD. The benefit on corticosteroid reduction in patients receiving biologics was reported in 9 studies. Three publications reported a positive impact of surgery on asthma and/or CRSwNP outcomes, and the effect of biologics on reducing the need of surgery was consistent across 6 studies.
Our results underscore an overall scarcity of scientific evidence on the treatment strategies for these frequent coexisting entities from an UAD approach but also identify several research gaps and unmet needs that should be addressed to ensure optimal diagnosis, management, and follow-up of these patients.
由于缺乏特定的研究，联合气道疾病（UAD）从联合视角处理上呼吸道和下呼吸道疾病对医疗保健专业人员来说具有挑战性。
本研究从 UAD 角度回顾了最近关于哮喘和慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）管理的科学证据。
对 PubMed、Scopus 和 Web of Science 进行了系统检索，针对 9 个研究问题进行检索，并纳入了 2015 年 1 月至 2021 年 7 月发表的研究。使用批判性评估技能计划进行了质量评估。
共有 32 篇出版物符合纳入标准。UAD 中 2 型炎症的控制（在 9 项研究中报告）与生物疗法相关，在 9 项研究中描述了生物疗法对哮喘、CRSwNP 和/或阿司匹林/非甾体抗炎药加重的呼吸道疾病结局的影响。然而，缺乏与 UAD 患者对生物制剂的反应相关的临床和/或生化标志物的科学证据。9 项研究报告了接受生物制剂治疗的患者减少皮质类固醇的益处。有 3 篇出版物报告了手术对哮喘和/或 CRSwNP 结局的积极影响，6 项研究一致表明生物制剂对减少手术需求有积极影响。
我们的结果强调了从 UAD 方法治疗这些常见共存实体的治疗策略总体上缺乏科学证据，但也确定了几个研究空白和未满足的需求，应解决这些问题以确保这些患者的最佳诊断、管理和随访。
