Chronic Rhinosinusitis and Associated Airway Diseases
Summary
Chronic rhinosinusitis (CRS) is an inflammatory condition of the nasal and paranasal sinus mucosa persisting for more than 12 weeks. It is commonly categorised into two clinical phenotypes: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP), each exhibiting distinct histopathological features. CRSwNP is frequently associated with type 2 inflammation, characterised by eosinophil infiltration, elevated interleukins 4, 5 and 13, and a dysregulated epithelial barrier. CRS often coexists with lower airway diseases, notably asthma, allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangiitis, reflecting the unified airway concept. The microbiome of the sinonasal cavity and its perturbation contribute to disease chronicity, while genetic and environmental factors influence endotypes of inflammation. Standard management comprises saline irrigation, topical corticosteroids and antibiotics when indicated, with endoscopic sinus surgery reserved for refractory cases. Emerging biologic therapies targeting IgE and type 2 cytokines have demonstrated efficacy in severe CRSwNP and comorbid asthma, offering personalised treatment avenues. Given its high prevalence and impact on quality of life, CRS and its associated airway disorders represent a significant global health challenge that demands integrated diagnostic and therapeutic strategies.
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Chronic Rhinosinusitis and Associated Airway Diseases publication trend
The graph below shows the total number of articles in chronic rhinosinusitis and associated airway diseases across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic rhinosinusitis: Persistent inflammation of the nasal and sinus mucosa lasting over 12 weeks.
Nasal polyps: Benign mucosal protrusions arising from inflamed sinonasal tissue, often associated with type 2 inflammation.
Type 2 inflammation: Immune response dominated by Th2 cells, eosinophils and cytokines IL-4, IL-5 and IL-13.
Eosinophil: White blood cell involved in allergic inflammation and parasitic defence, key in CRSwNP pathogenesis.
Endotype: Subclassification of disease defined by distinct molecular or immunological mechanisms.
Phenotype: Observable characteristics of a disease, including clinical presentation, histology and radiology.
Cytokine: Small protein released by cells to mediate and regulate immunity and inflammation.
Epithelial barrier: Mucosal lining that protects underlying tissue from pathogens and allergens; its dysfunction contributes to CRS.
References
- Exploring the immunopathology of type 2 inflammatory airway diseases. Frontiers in Immunology (2024).
- Prevalence and coexistence of type 2 inflammatory diseases. Clinical and Translational Allergy (2024).
- Clinically relevant phenotypes in chronic rhinosinusitis. Journal of Otolaryngology (2019).
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