EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: definitions and management

Uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis, typically characterized by a type 2 inflammatory reaction and by comorbidities including asthma, N-ERD and allergies. EUFOREA, the European Forum for Research and Education in Allergy and Airway Diseases, here proposes structured definitions to enable communication between clinicians and provides a practical algorithm to define type 2 inflammation in CRSwNP in daily clinic. A rational approach for the treatment of uncontrolled severe CRSwNP is discussed, evaluating the perspective and risks of surgery and efficacy and adverse events of biologics, based on currently available data. Further, possible combinations of surgery and biologics are discussed, and a rationale is provided. Here, it is of importance to adequately counsel the patient about both approaches to enable a decision-making process with an informed patient. Criteria for the selection of a biologic drug are provided, as several biologics for uncontrolled severe CRSwNP will be available within short time in many countries. Further, suggestions for monitoring of the drug effects are proposed, which support the recognition of responders to the therapy and consecutively the decision for continuation or discontinuation of the biologic.