Uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis, typically characterized by a type 2 inflammatory reaction and by comorbidities including asthma, N-ERD and allergies . EUFOREA, the European Forum for Research and Education in Allergy and Airway Diseases, here proposes structured definitions to enable communication between clinicians and provides a practical algorithm to define type 2 inflammation in CRSwNP in daily clinic . A rational approach for the treatment of uncontrolled severe CRSwNP is discussed, evaluating the perspective and risks of surgery and efficacy and adverse events of biologics, based on currently available data . Further, possible combinations of surgery and biologics are discussed, and a rationale is provided . Here, it is of importance to adequately counsel the patient about both approaches to enable a decision-making process with an informed patient . Criteria for the selection of a biologic drug are provided, as several biologics for uncontrolled severe CRSwNP will be available within short time in many countries . Further, suggestions for monitoring of the drug effects are proposed, which support the recognition of responders to the therapy and consecutively the decision for continuation or discontinuation of the biologic.
Index: biologics, chronic rhinosinusitis, endotypes, indication, nasal polyps, patient selection, sinus surgery, type-2 inflammation