ATP Project (Asthma afTer Polypectomy)
Condition: Asthma; Nasal Polyps
MeSH terms: Asthma; Nasal Polyps
Study type: Observational [Patient Registry]

Summary: 
      Inflammation of the nasal and bronchial mucosa characterizing rhinitis and asthma are
      probably manifestations of the same disease. Multiple functional observations, pathogenic and
      clinical support that assertion. It is noteworthy that most asthma patients, who underwent a
      nasal endoscopic polypectomy, improve your asthma after surgery. This improvement would be
      related to the administration of oral steroids that these patients usually receive after
      surgery, or the disappearance of nasal discomfort caused by nasal polyps to improve
      ventilation. But this does not explain why this improvement, in some cases lasting for months
      after the operation, and without receiving oral steroids. It is speculated that severe nasal
      inflammation due to nasal polyps stimulate the bone marrow to produce more eosinophils, an
      increased supply of blood eosinophils, and consequently, a major bronchial eosinophilic
      inflammation, aggravating asthma. However, it is noteworthy that studies have evaluated the
      clinical impact in asthma after endoscopic nasal polypectomy, are scarce or performed on a
      small number of cases, the results are inconsistent and do not allow categorically whether or
      not such positive association. And more importantly, none of them included measurements of
      airway inflammation and hypothesized relationship between bronchial eosinophilic inflammation
      and nasal polyposis, aclarar.La remains finding that provides nasal endoscopic polypectomy
      objective improvement of severe asthma it could be a future therapeutic option to consider in
      patients with asthma and rhinosinusal polyposis.
    

Detailed description: 
      Sinonasal polyposis (SP) is a chronic inflammatory disease of the lining of the nasal
      passages and sinuses, with a prevalence of approximately 2-3% of the general population. The
      prevalence of asthma in patients diagnosed with SP is much greater than that of the general
      population and can reach half of the cases and indicate a more severe phenotype and worse
      control in asthmatic patients without SP. It is possible that the pathophysiologic mechanisms
      underlying the development of SP and concomitant asthma are the same and both processes can
      be considered the same disease.

      Recommendations of major clinical practice guidelines for the treatment of SP include
      administration of intranasal topical steroids at high doses, and in subjects who do not
      respond to this treatment or are more severe, administering a course of systemic steroids
      orally for 10-14 days or surgical intervention including polypectomy and removal of the
      diseased mucosa endoscopically, known as functional endoscopic sinus surgery (FESS).

      In this context, it is noteworthy that most asthma patients, who underwent functional
      endoscopic sinus surgery for bilateral polyposis (FESS-BP) stated it dramatically improved
      their asthma after surgery. This improvement could be related to the effect of oral steroids
      these patients often receive after surgery, or the disappearance of nasal discomfort caused
      by nasal polyps as ventilation improves after the intervention. However, these reasons do not
      sufficiently explain the fact that this improvement, in some cases extends for months after
      surgery, when patients are no longer receiving oral steroids.

      It has been speculated that severe nasal inflammation which involves the presence of nasal
      polyps would constantly stimulate the bone marrow, causing on the one hand increased
      production of eosinophils and the other an increase in adhesiveness, and thus, an important
      eosinophilic bronchial inflammation. This is in line with a usual clinical observation
      according to which patients with asthma and sinonasal polyposis, often suffer more severe
      asthma; and severe sinus inflammation is one of the aggravating factors recognized in severe
      uncontrolled asthma.

      However, studies that have assessed the clinical impact in asthma after FESS-BP, are only a
      few or have been performed on a small number of cases. Consequently, the results are
      inconsistent and do not allow to categorically establish whether this positive association
      exists or not. Most importantly, however, none of them included measurements of bronchial
      inflammation in the study variables, so that the hypothesis of the possible relationship
      between eosinophilic bronchial inflammation and nasal polyposis remains without having been
      tested.

      Moreover, the finding that the FESS-BP provides an objective improvement of asthma, could be
      a future therapeutic option to consider in patients with severe asthma and sinonasal
      polyposis.
    

Intervention name(s): Asthma with NP and require surgery
Intervention type(s): Procedure
Intervention description(s): To evaluate the effect on asthma of functional endoscopic sinus surgery of bilateral sinonasal polyposis in patients diagnosed with persistent asthma and grade II or III sinonasal polyposis.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients with persistent asthma and grade II and III bilateral sinonasal polyposisand, by
        voluntary decision of the otolaryngologist and the patient, who will offer alternatives
        treatment to the candidate patient, following the recommendations of clinical practice
        guidelines.

        If the patient is indicated in routine clinical practice FESS-BP, will be offer to enter to
        the study.

        If the patient is NOT indicated in routine clinical practice FESS-BP or reject
        intervention, will be also offer to enter to the study.
      
Keywords: asthma; sinonasal polyposis; eosinophilic bronchial inflammation; endoscopic sinus surgery