The Evolving Role of Biologics and TSLP Inhibition in Severe Asthma and Upper Airway Disease - Episode 9
Unified Airway Disease Presentation in Clinic
Not every patient with nasal polyps is allergic, and no test reliably separates those who are. The panel discusses how referral patterns skew what each specialist believes.
"Unified Airway Disease Presentation in Clinic," takes up a question that looks different from every specialty's waiting room.
Dr. Chupp asks Dr. Ross what percentage of patients presenting with nasal polyps actually have allergic sensitization, noting the field increasingly recognizes two phenotypes: the systemically allergic patient, and the patient without sensitization. Dr. Ross reaches for eosinophilic esophagitis as a parallel. She sees individuals who test positive for absolutely everything and others with identical findings who test negative to every test run. No tool yet distinguishes them. The consolation, she says, is that treatment options now exist for either end result. She estimates about 75% of her patients have some allergy driving their phenotype, while conceding her office is skewed; her non-allergic patients likely land in the ENT office instead.
Dr. Wechsler says the distinction is genuinely hard, and clinicians often treat for one, then the other. Patients referred to him with asthma and sinus disease frequently arrive after a course of antibiotics that may not have helped what is actually a type 2 inflammatory problem. Around 30% to 40% of his asthma patients have concomitant upper airway disease, and treating it aggressively pays off in both directions.
Dr. Ross argues specialists must go beyond the presenting complaint, because a good history teases out polyps, sinus issues, repeat surgeries, and antibiotics. Dr. Wechsler adds that it is not difficult: ask about sense of smell, the best single indicator of upper airway disease.
Dr. Hanania reports his CRS and polyp patients skew non-allergic with late-onset asthma and significant polyposis, and roughly 15% have aspirin or NSAID-exacerbated disease. He describes starting multidisciplinary discussions with rhinology and allergy, calling cross-specialty communication an area still raw in practice.
In "Managing Both Upper and Lower Airway Diseases," the panel will ask what happens to aspirin desensitization once biologics arrive.
