Treatment with biologics in severe asthma and chronic rhinosinusitis

Abstract

The concept of the common airway is a paradigm shift in the understanding of common diseases such as allergic rhinitis, chronic rhinosinusitis and asthma. These clinical entities share common epidemiology and probably some pathophysi-ological cornerstones. In asthma, airway obstruction and hyperresponsiveness can be well-controlled by local glucocor-ticoid therapy. Chronic rhinosinusitis with nasal polyps is treated by local glucocorticoids, prolonged systemic antibiotic administration, systemic glucocorticoid pulses and surgery. Suboptimal management of the disease in the upper airways can also lead to worsening of the condition in the lower airways. Patients with severe asthma and chronic rhinosinusitis with nasal polyps have persistent uncontrolled symptoms despite maximal treatment; however, receiving systemic glu-cocorticoids carries a growing risk for long-term side effects. Biologicals are the latest, next-generation treatment used in asthma and chronic rhinosinusitis with nasal polyps. These antibodies target only specific inflammation pathways. Therefore, they represent essentially personalized medicine. Different pathways seen in upper and lower airway diseases can be recognized by characteristic biomarkers. Ideally, early endotypization would help us select the particular type of endotype tailored treatment as quickly as possible.