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Chronic Rhinosinusitis with Nasal Polyps: More Than Just Nasal Obstruction

Author : Sanofi
Editorial team

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease associated with frequent recurrence despite effective treatments.1–5

Understanding the role of type 2 inflammation, contributing factors, and treatment strategies, including biologics, can improve management and prevent relapse, potentially offering better outcomes for CRSwNP patients.1–7

Overview of CRSwNP
  • Chronic type 2 inflammation worsens nasal congestion and may cause polyp growth.1,2
  • Nasal congestion is a key symptom in CRSwNP, but does not fully capture the multitude of other symptoms such as smell loss.3
  • Persistent type 2 inflammation can contribute to nasal polyp recurrence.2–7

Nasal congestion is a manifestation of the underlying disease rather than the disease itself8

 

Inflammatory changes associated with CRSwNP6
inflammatory-changes
  • Nasal polyps can cause significant congestion, obstructing airflow to the olfactory cleft.3,9,10
  • Treating congestion without addressing inflammation potentially cause recurring symptoms in CRSwNP such as smell loss and facial pain.4,7,11–13
  • Effective management of CRSwNP requires targeting the root cause of type 2 inflammation.3–5,7,9

 

CRSwNP is marked by elevated levels of type 2 inflammatory cytokines (IL-4, IL-5, and IL-13)4,7

IL-4

IL-13

IL-5
Differentiation of Th2 and ILC2 cells  

Activation of M2 macrophages; B-cell switching and IgE production

 Eosinophil activation in bone marrow
Mast cell activation and trafficking to tissue;
mast cell and basophil degranulation		  
Epithelial barrier dysfunction and microbiome imbalance  

Tissue remodeling (e.g., subepithelial fibrosis)

  
  Goblet cell hyperplasia and mucus production  
Eosinophil recruitment and trafficking to tissue

Type 2 inflammation leads to nasal congestion, rhinorrhea, loss of smell and facial pain/pressure

 

In CRSwNP, chronic type 2 inflammation causes abnormal changes in the nasal mucosa1

 

Epithelial remodeling in CRSwNP1,4,5,7
epithelial-remodelling

In CRSwNP, IL-4 and IL-13 increases perisotin expression, causing fibrosis, edema, and barrier dysfunction4

Eosinophil infiltration releases inflammatory mediators, causing epithelial damage1

Type 2 cytokines increase matrix protein, worsening congestion and potentially contributing to formation of nasal polyps2

Nasal polyp recurrence remains a significant challenge in the management of CRSwNP1,3,6,7,11,12,14

 

Factors associated with the recurrence of nasal polyps

Persistent type 2 inflammation2,3,7

  • Potentially drives nasal polyp growth despite initial treatment

Comorbid conditions3,7

  • Asthma
  • Allergic rhinitis
  • Aspirin-exacerbated respiratory disease

Genetic factors5

  • Increase susceptibility
  • First-degree relatives of CRSwNP patients are at 4-fold increased risk

In CRSwNP, nasal symptoms can have a profound effect on patient’s quality of life (QoL)3,9
Reduced sleep quality
Reduced sleep quality
Social impact
Social impact
Fatigue/tiredness
Fatigue/tiredness
Depression/anxiety
Depression/anxiety
Frustration/irritability
Frustration/irritability
Impact on daily activities/work
Impact on daily activities/work

The chronic nature of CRSwNP requires long-term management strategies to control symptoms and prevent exacerbations.2

Abbreviations

CRSwNP, chronic rhinosinusitis with nasal polyps; IgE, immunoglobulin E; IL, interleukin; ILC2, type 2 innate lymphoid cells; QoL, quality of life; Th2, T-helper 2 cells.

  1. Lee K, et al. Int J Mol Sci. 2021;92:910;

  2. Gong X, et al. Front Immunol. 2023;14:1238673;

  3. Mullol J, et al. J Allergy Clin Immunol Pract. 2022;10(6):1434-1453.e9;

  4. Bachert C, et al. Front Immunol. 2024;15:1356298;

  5. Stevens WW, et al. J Allergy Clin Immunol Pract. 2016;4:565-572;

  6. Schleimer RP. Annu Rev Pathol. 2017;12:331-357;

  7. Maspero J, et al. ERJ Open Res. 2022;8(3):00576 20219;

  8. Nasal Obstruction. Available at Hopkins Medicine. Accessed on 13 Nov 2024;

  9. Hopkins C, et al. Otolaryngol Head Neck Surg. 2024;170(4):1173-1182;

  10. Ye P, et al. Front. Surg. 2022;9:870682;

  11. Buchheit KM and Holbrook EH. Chronic rhinosinusitis with nasal polyposis: Management and prognosis. UpToDate. 2023. Available at UpToDate. Accessed on 13 Nov 2024;

  12. Tsunemi Y, et al. Am J Rhinol Allergy. 2024;38(1):14-22;

  13. Yan X, et al. Laryngoscope Investig Otolaryngol. 2020;5(6):992-1002;

  14. Fokkens WJ, et al. Rhinology. 2020;58(Suppl 29):1-464.

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MAT-BE-2600574 (v1.0) 04/05/2026