Severe Bronchial Asthma and Chronic Polypous Rhinosinusitis: Achieving Control with Genetic Engineering Biological Therapy

Abstract

Aim. To evaluate the effect of immunobiological therapy on the course of severe bronchial asthma combined with chronic polypous rhinosinusitis. Design. Cohort, comparative, prospective study. Materials and methods. The study included 62 patients with severe bronchial asthma and chronic polypous rhinosinusitis, including 45 (73%) women and 17 (27%) men, who received additional therapy with immunobiological drugs for 12 months. Allergic phenotype of bronchial asthma was recorded in 38 (61%) patients, non-allergic phenotype in 24 (39%). Patients received the following genetically engineered biological therapy: dupilumab — 29 (47%) people, benralizumab — 26 (42%), omalizumab — 2 (3%), mepolizumab — 5 (8%). Results. Before immunobiological therapy was initiated, all patients had uncontrolled asthma: Asthma Control Test scores were 16 [12; 19] points, with patients reporting a daily need for short-acting β2-agonists, the need to call an ambulance, and the development of exacerbations requiring systemic glucocorticosteroids. Spirometry results revealed that, prior to the study, the forced expiratory volume in first second (FEV1) was below 80% in 34 (55%) patients. An initial assessment of chronic polypous rhinosinusitis revealed that nasal symptoms significantly impacted quality of life in all patients, with a significant reduction in paranasal sinus pneumatization. Twelve months after initiation of the genetically engineered biological therapy, 48 (77%) participants were completely free of asthma attacks (р < 0.001), while 14 (23%) patients experienced them 1–2 times a week. Mild exacerbations of bronchial asthma were recorded in 6 (10%) patients; they did not require inpatient treatment or the administration of systemic glucocorticosteroids. The daily need for short-acting β2-agonists significantly decreased (p < 0.001). After 12 months of additional therapy, FEV1 below 80% was recorded in 20 (32%) patients. Patients noted a significant reduction in complaints of nasal congestion, olfactory impairment, posterior rhinorrhea, and the need for decongestants. Conclusion. Our study confirmed the effectiveness of genetically engineered biological therapy in patients with severe asthma and polypous rhinosinusitis. All medications demonstrated positive results, improving asthma control and lung function. Keywords: severe bronchial asthma, chronic polypous rhinosinusitis, achieving control, genetically engineered biological therapy