Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus

De Corso E.;Vaghi A.;Corbò M.;Pipolo C.;Vultaggio A.;Matucci A.;Cantone E.;Senna G.;Caminati M.;Canevari F. R.;Lombardi C.;Detoraki A.;Canonica G. W.;Schroeder J. W.;D'Amato M.;Crivellaro M. A.;Gelardi M.;Salzano F. A.;Mattavelli D.;Rampinelli V.;Macchi A.;Pasquini E.;Casale M.;Gallo S.;Pelaia G.;Crimi C.;Carpagnano G. E.;Heffler E.;Nettis E.;Bilò M. B.;Seccia V.;Ottaviano G.;Micheletto C.;Del Giacco S.;Caruso C.;Bagnasco D.;Bonini M.;Menzella F.;Passali G. C.;Maggiore G.;Di Marco F.;Passali F. M.;Di Michele L.;Ricci G.;Galli J.;Pagella F.

2025-01-01

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Abstract

Objective: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and share common underlying pathophysiological mechanisms. This study addresses challenges in the diagnosis and treatment of multimorbid patients with CRSwNP and asthma providing new insights for their management. Methods: Using a modified Delphi method, a scientific board of 40 Italian clinicians (pulmonologists, allergists/clinical immunologists, and ear, nose, and throat specialists) developed consensus statements regarding the multimorbid patient with severe CRSwNP and asthma and including the disease burden, assessment, treatment and multidisciplinary management of multimorbid patients. Results: All statements reached consensus. Experts acknowledged the substantial disease burden, the key pathophysiological role of type 2 inflammation in multimorbid patients and the need for multidisciplinary care. The use of biologics represents a highly effective therapeutic opportunity for patients with comorbidities, optimising overall outcomes. Integrated care pathways and regular multidisciplinary re-assessment were deemed essential for treatment decisions and improved care in multimorbid patients. Conclusions: This consensus highlights the value of a multidisciplinary approach for multimorbid CRSwNP and asthma patients, advocating for endotype-driven therapies and standardised pathways in clinical practice.