In CRSwNP, Type 2 Endotype Has Worse Impact on Quality of Life

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Type 2 CRSwNP is linked to worse health-related quality of life, with higher rates of smell loss and rhinorrhea emerging as key differences in symptom burden.

“In current clinical practice, primary diffuse chronic rhinosinusitis with nasal polyps (CRSwNP) is classified into two endotypes: type 2 and non-type 2,” researchers wrote in Clinical and Translational Allergy. “Previous studies on sinonasal health-related quality of life (HRQOL) in CRS have primarily focused on differences between phenotypes.”

In a single-center prospective trial, Oliver Pfaar, MD, PhD, and colleagues aimed to assess HRQOL between the two endotypes in patients with CRSwNP. The researchers included patients with CRSwNP who had been referred for surgery and used a 20-item version of the Sino-Nasal Outcome Test (SNOT) questionnaire to assess HRQOL.

The study included 122 patients, most of whom (92.6%) had endotype 2. Age and sex distributions were similar between groups, but the type 2 disease group had a higher percentage of smokers, and no patients with non-type 2 had undergone endoscopic sinus surgery.

Symptoms & SNOT-22 Domains

 Across all patients, the mean SNOT-20 score was 38.4, and chronic rhinosinusitis was deemed severe in 57.4% of the study population. Patients with type 2 disease had a significantly worse SNOT-20 score (mean, 39.4 vs 26.7; P=0.01).

Within SNOT-20 subdomains, patients with type 2 CRSwNP had higher primary nasal symptom scores (P=0.003), but the researchers reported no significant differences in secondary rhinologic symptoms or general symptoms of quality of life.

The highest median symptom scores in endotype 2 CRSwNP were for decreased sense of smell, followed by nasal obstruction, rhinorrhea, thick nasal discharge, and throat clearing. In non-type 2 CRSwNP, the most severe nasal symptoms were nasal obstruction and thick nasal discharge. Severe nasal symptoms that significantly differed between type 2 and non-type 2 CRSwNP included rhinorrhea (P<0.001) and decreased sense of smell (P=0.002).

The most common symptom across all patients was nasal obstruction, seen in 94.7% of patients with type 2 CRSwNP and 88.9% of those with non-type 2 CRSwNP (P=0.4). Patients with type 2 CRSwNP experienced decreased sense of smell (83.2% vs 44.4%; P=0.01) and rhinorrhea (83.2% vs 0.0%; P<0.001) significantly more often than the non-type 2 group. Facial pain was neither severe nor prevalent in both endotypes.

Incorporating HRQOL Impact in Clinical Settings

Based on these findings, Dr. Pfaar and colleagues noted that type 2 CRSwNP incurs a worse impact on HRQOL compared with non-type 2 CRSwNP.

“This study is the first to examine the impact of the current endotypes on symptom severity in CRSwNP,” they wrote. “The endotype of CRSwNP has a significant impact on quality of life and specific nasal symptoms.”

The researchers also noted the prominence of decreased sense of smell and rhinorrhea in patients with type 2 CRSwNP.

“Both of these symptoms might provide endotypical and therefore pathophysiological information,” Dr. Pfaar and colleagues wrote. “Further studies, including real-world analyses, are needed to confirm these findings and establish their relevance in defining key outcomes for future interventional trials, particularly those evaluating biologic therapies.”