The burden of Chronic Rhinosinusitis with Nasal Polyps and its relation
to Asthma in Finland
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP)
is commonly associated with asthma. Treatment of CRSwNP includes
intranasal and systemic corticosteroids, with non-responsive patients
commonly considered for endoscopic sinus surgery (ESS). This nationwide
register-based study evaluated the incidence, prevalence, and treatment
burden of CRSwNP in Finland, and their association with the presence and
severity of comorbid asthma. Methods: Electronic health records
of patients diagnosed with CRSwNP between 1.1.2012-31.12.2018 in Finnish
specialty and primary care were included in the study. The patients were
divided into subgroups based on presence, severity, and control of
asthma: no asthma, mild to moderate asthma, severe controlled asthma,
and severe uncontrolled asthma. A mean cumulative count of ESS was
calculated over time per subgroup. Results: The prevalence of
CRSwNP increased from 602.2 to 856.7 patients per 100 000 population
between years 2012 and 2019 (p < 0.001). A total of 18 563
patients (59.9% male) had incident CRSwNP between 2012 and 2019, with
27% having asthma, 6% having severe asthma, and 1.5% having severe
uncontrolled asthma. In the no asthma, severe controlled asthma, and
severe uncontrolled asthma subgroups, systemic corticosteroids were used
by 54.1%, 94.9% and 99.3% (p < 0.001), respectively, while
the ESS count three years post diagnosis was 0.49, 0.68 and 0.80,
respectively. Conclusions: The prevalence of CRSwNP showed a
significant increase in the recent decade in Finland. Comorbid asthma,
and in particular severe asthma, increased the probability of receiving
systemic corticosteroids and undergoing ESS. Thus, improved management
of CRSwNP in patients with comorbid asthma is urgently needed.