Nasal polyps are a chronic inflammation that is often associated with other disorders such as asthma, respiratory allergy, rhinosinusitis… A combination that could be avoided, according to medical societies, with access to innovative treatments that do not yet have public funding .
Three medical societies, the SSpanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC)the Spanish Society of Allergology and Clinical Immunology (SEAIC) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) agree to claim funding for new treatments for nasal polyps that are not within the reach of all patients due to their high price.
What are nasal polyps?
- Chronic inflammation of the paranasal sinuses causes whitish formations inside, nasal polyps, according to the SEORL-CCC.
- It is about benign polypsbut which can grow to the point of completely obstructing the nostrils.
- They can be given at any agebut they are more common around the age of 40 and men suffer more than women.
Despite the scientific advances that have been made in the study of nasal polyposis, its causes are unknown.
Initially it was believed that it developed due to an allergy, but later studies have shown that this is not always the case, as two out of three people who have polyps do not suffer from an allergy.
Among the reasons that can produce this chronic inflammation of the nasal mucosa have been studied, among others, fungi, viruses, allergic reactions and toxins, but there is still a lack of research to clarify exactly what the origin of nasal polyposis is.
- Nasal congestion or obstruction: at the beginning of the disease, a sensation of nasal congestion usually appears. Already in advanced stages, the obstruction is clear, causing nasal respiratory failure.
- Rhinorrhea or nasal mucus: can be bilateral, anterior or posterior.
- Headache and eye discomfort are less frequent. Facial pain projects over the nasal or sinus area and is usually described as a feeling of heaviness. They are mainly located in the maxillary or mediofacial regions.
- Loss of smell: it can be the first symptom and is progressive, being able to cause the complete loss of the sense of smell or anosmia.
- This disease has a high negative impact on both the life quality as in the dream of the patients, who indicate that as a result they lack energy.
There are three phases in the treatment of nasal polyposis:
- 1.- First of all the administration of pharmacological therapy.
- 2.- If the patient does not respond, the surgery.
- 3.- Finally at biological drugs based on monoclonal antibodies.
“Biologics have meant a great therapeutic advance in recent years for those patients who fail to control their disease after treatment with intranasal and oral corticosteroids and at least one nasal surgery,” according to doctor José Antonio Castillo, president of the rhinitis, rhinosinusitis and nasal polyposis working group of the SEPAR asthma area.
“However – he warns – we are facing the obstacle of their lack of funding”.
The Dr. Carlos Colás, president of the SEAIC rhinoconjunctivitis committeeindicates, for its part, that “the application of therapies with biological drugs can prevent the patient from having to face multiple re-interventions”.
For its work, it is necessary to carry out studies that value its duration and the cost-effectiveness ratio.
“It is essential to have biomarkers that allow us to select the patients who can best benefit from them. In addition, it will be necessary for the control of the same to be carried out in specialized multidisciplinary units made up of otorhinolaryngologists, allergists and pulmonologists”, he points out.
For its part, the endoscopic surgerya nasal is a minimally invasive technique that allows the paranasal sinuses to be opened and the inflammatory tissue removed. This type of intervention has shown good postoperative results in long-term studies, with a follow-up of more than twelve years of patients.
The chronic rhinosinusitis with nasal polyposis, which affects around 280,000 Spaniards, causes symptoms such as breathing difficulties, nasal mucus and ansomia, which could be avoided to a large extent if patients accessed the available treatments, as warned by SEORL-CCC, SEAIC and SEPAR.
“Nasal polyposis is caused by a chronic nasal inflammation that is often associated with the asthma severe or respiratory allergy and intolerance to aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) and the treatment influences the control of the associated asthma”, says Dr. Isam Alobid, president of the Rhinology, Allergy and Anterior Skull Base commission of SEORL-CCC
One in four patients with asthma has nasal polyps, a condition suffered by 3 to 6% of Spaniards and for whom access to the most effective drugs is complex due to the lack of funding for them, report the aforementioned medical societies . .
Guide to nasal polyps
SEORL-CCC, SEAIC and SEPAR have developed the POLINA 2022 Guide aimed at specialist doctors in the areas of otorhinolaryngology, allergology and pulmonology, and also involves other specialties including Primary Care doctors, pharmacists and patients.
This guide promotes coordination between medical specialists and multidisciplinary work for the benefit of the patient for an early diagnosis and avoiding delays and duplication of diagnostic tests.
The document further provides suggestions/unmet needs for future research in this pathology and will provide updated guidance on definitions and outcome measurement for such research and in different settings.