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Uncontrolled Persistent Asthma
is Associated with Multiple Type 2
Inflammatory Comorbidities1,2

 

Upper airway comorbidities

Click on the airways to reveal more about CRSwNP and asthma

Adapted from Gandhi NA et al, 2016.3


Nasal polyps
  • In patients with chronic rhinosinusitis, 58%a had nasal polyps
    and comorbid asthma
    4
  • The presence of comorbid asthma is the key predictor
    of increasing severity in patients with combined nasal polyps
    and chronic rhinosinusitis4

a Compared with 25% of patients with nasal polyps without comorbid asthma.


Chronic rhinosinusitis
with nasal polyps (CRSwNP)
  • 24% of patients with CRSwNP had premorbid
    and concurrent asthma compared with 11%
    of those without chronic rhinosinusitis2
Allergic rhinitis
and rhinosinusitis
  • 74%b of patients with uncontrolled moderate-to-severe asthma had allergic rhinitis and 10%c had rhinosinusitis1

b Compared with 65% of patients with controlled moderate-to-severe asthma.
c Compared with 6% of patients with controlled moderate-to-severe asthma.

 

IL-4, IL-13, and IL-5 are key drivers
in
chronic rhinosinusitis with nasal polyps (CRSwNP)5

Adapted from Akdis CA et al, 2013.5


CRSwNP involves a distinct Type 2 cytokine profile, including5,6:
  • A lack of regulatory T-cell (Treg) function
  • Local IgE production induced by IL-4 and IL-13
  • Eosinophilic inflammation induced by IL-4 and IL-13, as well as IL-5
Upper airway comorbidities may signal
Type 2 inflammation in the lower airway7,8
References:
  1. Marcus P, Arnold RJG, Ekins S, et al; CHARIOT Study Investigators. A retrospective randomized study of asthma control in the US: results of the CHARIOT study. Curr Med Res Opin. 2008;24(12):3443-3452.
  2. Tan BK, Chandra RK, Pollak J, et al. Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2013;131(5):1350-1360.
  3. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50.
  4. Pearlman AN, Chandra RK, Chang D, et al. Relationships between severity of chronic rhinosinusitis and nasal polyposis, asthma, and atopy. Am J Rhinol Allergy. 2009;23(2):145-148. doi:10.2500/ajra.2009.23.3284
  5. Akdis CA, Bachert C, Cingi C, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2013;131(6):1479-1490.
  6. Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4(4):565-572.
  7. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4.
  8. Ray A, Raundhal M, Oriss TB, Ray P, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403.
  9. Robinson D, Humbert M, Buhl R, et al. Revisiting type 2-high and type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47(2):161-175.