RESUMO
In this edition of Rhinology we feature the work of Connell and colleagues from Australia on chronic rhinosinusitis that describes an interesting new pipeline to characterize the bacterial composition of microbiota. We are constantly exposed to a multitude of micro-organisms in the environment and our immune system has the important task discerning and fighting off potential threats. In most people the immune system is doing its job properly and prevents anything untoward from happening. On occasion, a microbe slips by the first (innate) level of defense and we might suffer from an infection. This then activates the second layer of (the adaptive) defense tasked to clear this infection. Sometimes the immune system gets its wrong and starts a full-out defense against something harmless, and an allergy is born. The task of the immune system of doing what is right is even more difficult than it might seem at first sight. In addition to these incidental potential threats, our mucosal surfaces are lined with commensal bacteria which contributes to the complexity of our environment. This collection of bacteria or microbiome has become a major focus of research, as the composition of this microbiome seems related to the health state of the individual. Originally the relationship between the gut microbiome and the development of asthma and allergy was the main focus. In recent years, the focus has been broadened to include the microbiome of the upper and lower airways. In addition to allergy, our field has also been given more and more attention to studying the microbiome in chronic rhinosinusitis.
Assuntos
Asma , Microbioma Gastrointestinal , Microbiota , Rinossinusite , Sinusite , Humanos , Sinusite/microbiologia , BactériasRESUMO
BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhoea has different aetiologies, with spontaneous leaks related to female gender and obesity. Limited data is available on patient characteristics and surgical outcomes across different aetiologies of CSF leaks in relatively non-obese populations. METHODS: Retrospective cohort study from two tertiary referral centres including adult patients that underwent surgical closure of a CSF leak, divided into four aetiologies: traumatic, iatrogenic, secondary to structural intracranial pathology (SIP), and spontaneous. Data included patient characteristics, presenting symptoms, preoperative radiologic findings, intracranial pressure (ICP) and surgical outcomes. RESULTS: 72 patients were included: 9 traumatic, 15 iatrogenic, 4 SIP and 44 spontaneous leaks. Primary surgical success was 79%, rising to 93% with reinterventions. Spontaneous leak cases displayed highest female proportion and BMI. A meningo(-encephalo)cele was present in 33 patients and was associated with surgical failure and previous meningitis. No significant differences were observed between different aetiologies regarding patient characteristics, presenting symptoms, or surgical success rates. CONCLUSIONS: Even in a relatively non-obese population, the majority of CSF leaks is spontaneous and associated with female gender and obesity. Otherwise, no differences exist across aetiologies regarding patient characteristics, presenting symptoms or surgical success.
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Rinorreia de Líquido Cefalorraquidiano , Adulto , Humanos , Feminino , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Estudos Retrospectivos , Centros de Atenção Terciária , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Obesidade , Doença Iatrogênica , Resultado do TratamentoRESUMO
BACKGROUND: Increased blood eosinophil count (BEC) is common in patients under dupilumab treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). This study investigated the prevalence and consequences of hypereosinophilia and to help define patients at risk. METHODS: Real-life, prospective observational cohort study of patients treated with dupilumab for severe CRSwNP. Eligible patients were adult and biological-naive (N=334). All BEC values at baseline and during treatment were reported. Patients with a follow-up of >= 1 year were included to define patients at risk for hypereosinophilia by comparing baseline BEC values (N=218). Furthermore, clinical characteristics and therapeutic consequences for patients with BEC >= 3.0 were noted. RESULTS: Hypereosinophilia developed in a minority of patients, with a peak at week 12 (16.2% with BEC >= 1.5, and 1.7% >= 3.0) in cross-sectional analysis. BEC >= 1.5 developed in 28.9% and BEC >=3.0 in 4.6% of cases with a minimal 1-year follow-up. Baseline BEC was significantly higher for patients developing BEC >= 1.5 and BEC >=3.0, with an optimal cut-off point of 0.96 to predict developing BEC >= 3.0. CONCLUSIONS: Blood eosinophil count (BEC) >= 1.5 is transient and usually abates with no therapeutic interventions and BEC >= 3.0 is rare. Hypereosinophilic syndrome did not occur and switching to a different biological was rarely employed. A baseline BEC of >=1.0 can be a reason for extra caution.
Assuntos
Anticorpos Monoclonais Humanizados , Eosinofilia , Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Adulto , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/epidemiologia , Estudos Transversais , Estudos Prospectivos , Rinite/complicações , Rinite/tratamento farmacológico , Sinusite/complicações , Sinusite/tratamento farmacológico , Sinusite/epidemiologia , Doença CrônicaRESUMO
BACKGROUND: There is no known predictor for olfactory function recovery with dupilumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP). This study assessed whether patient-reported recovery of olfactory function on oral corticosteroids (OCS) is a prognostic factor. METHODS: Retrospective analysis of pre-biological OCS-responsiveness on olfactory functioning (OCS-responsive or OCS-unresponsive; OCS-r and OCR-u, respectively) as predictor for olfactory functioning after 6 months of dupilumab therapy for severe CRSwNP. RESULTS: 212 CRSwNP patients treated with dupilumab were divided between OCS-r (reported improvement of olfactory function with OCS before dupilumab treatment, n = 152), and OCS-u (OCS-unresponsive; no such improvement, n = 60). Olfactory function was tested with Sniffin's Sticks Identification Test (12 pens; SSIT-12). At baseline, both groups had a median SSIT-12 score of 3 / 12 indicating anosmia. Hyposmia and normosmia rates were also comparable (5.9% and 3.3% in OCS-r, respectively; 5.0% and 1.7% in OCS-u, respectively). After 6 months of dupilumab treatment, OCS-r showed higher olfactory scores (median SSIT-12: 8/12; 52.6% hyposmia and 17.8% normosmia) than OCS-u (median SSIT-12: 5/12; 31.7% hyposmia and 3.3% normosmia). The positive predictive value of OCS-responsiveness on scoring <7 (normosmia/hyposmia) on the SSIT-12 after 6 months of dupilumab treatment was 70.4%. Conversely, the negative predictive value of OCS-unresponsiveness on scoring <7 (anosmia) on the SSIT-12 after 6 months of dupilumab treatment was 65.0%. CONCLUSION: Patients who report olfactory function improvement on OCS have a higher chance of recovery of olfactory function during the first six months of treatment with dupilumab than patients who do not.
Assuntos
Anticorpos Monoclonais Humanizados , Pólipos Nasais , Rinite , Sinusite , Humanos , Anticorpos Monoclonais Humanizados/uso terapêutico , Estudos Retrospectivos , Sinusite/tratamento farmacológico , Pólipos Nasais/tratamento farmacológico , Pólipos Nasais/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Rinite/tratamento farmacológico , Doença Crônica , Recuperação de Função Fisiológica , Adulto , Olfato/efeitos dos fármacos , Corticosteroides/uso terapêutico , Transtornos do Olfato/tratamento farmacológico , Resultado do TratamentoRESUMO
The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) defines markers for type2 inflammation in the context of indicating biological therapy in severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) as either a total serum immunoglobulin E (total-IgE) <100 kU/L, a blood eosinophil count (BEC, expressed as -109 cells / L) >=0.25, or a tissue eosinophil count >=10 per high power field (HPF) (1). Recently, an EPOS/EUFOREA expert panel advised to lower the threshold for BEC from >=0.25 (EPOS2020) to >=0.15 (EUFOREA2023) to align with thresholds used for biological indication in asthma patients (2). As far as we know, there is no literature supporting the cut-off value for total-IgE.
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Biomarcadores , Eosinófilos , Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/terapia , Sinusite/complicações , Sinusite/sangue , Sinusite/terapia , Rinite/complicações , Rinite/sangue , Doença Crônica , Biomarcadores/sangue , Biomarcadores/análise , Imunoglobulina E/sangue , Contagem de Leucócitos , RinossinusiteRESUMO
Severe chronic rhinosinusitis with nasal polyps (CRSwNP), a form of diffuse bilateral (usually type 2) CRS, is a debilitating disease with a significant impact on quality of life (QoL). With novel knowledge and treatment options becoming available, there is a growing need to update or revise key definitions to enable communication across different specialties dealing with CRS, and to agree on novel goals of care in CRSwNP. The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) and EPOS expert members discussed how to measure treatment responses and set new treatment goals for CRSwNP. In this paper a consensus on a list of definitions related to CRSwNP is provided: control, remission, cure, recurrence/exacerbation, treatable traits, remodeling, progression, and disease modification. By providing these definitions, the involved experts hope to improve communication between all stakeholders involved in CRSwNP treatment for use in routine care, basic and clinical research and international guidelines aimed to harmonize and optimize standard of care of patients with CRSwNP in the future.
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Pólipos Nasais , Rinite , Sinusite , Humanos , Sinusite/terapia , Rinite/terapia , Doença Crônica , Pólipos Nasais/terapia , Pólipos Nasais/complicações , Qualidade de VidaRESUMO
BACKGROUND: In chronic rhinosinusitis (CRS), aim of treatment is control of disease. EPOS2020 suggests the use of visual analogue scale (VAS) measurements on several symptoms. We aim to determine if individual VAS items can be replaced by widely used SinoNasal Outcome Test-22 (SNOT-22) items when determining control of disease, to avoid using double measurements and to stimulate its use in clinical practice. METHODS: Analyses were made on correlations between individual SNOT-22 scores and symptom-specific questions from consecutive patients with CRS visiting our tertiary referral rhinologic clinic for the first time. RESULTS: 157 CRS patients were included. Correlations of individual items were strong (r greater than 0.8). Best parity in sensitivity, specificity, positive predicting value, negative predicting value, odds ratio and Receiver Operating Characteristic curves were found in individual item score of VAS greater than 5 and SNOT item-score. This cut off is valid for measuring control of disease, combining several nasal, facial pain and sleep symptoms (controlled, partially controlled and uncontrolled). CONCLUSION: There is strong correlation between individual items measured as SNOT or VAS. For the definition of CRS disease control, as proposed in EPOS2020, the use of symptoms specific SNOT 23 is predictive of VAS greater than 5.
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Rinite , Sinusite , Humanos , Teste de Desfecho Sinonasal , Escala Visual Analógica , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapia , Doença Crônica , Qualidade de VidaRESUMO
Severe chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating disease with a significant impact on the quality of life (QoL). It is typically characterized by a type 2 inflammatory reaction and by comorbidities such as asthma, allergies and NSAID-Exacerbated Respiratory Disease (N-ERD). Here, the European Forum for Research and Education in Allergy and Airway diseases discusses practical guidelines for patients on biologic treatment. Criteria for the selection of patients who would benefit from biologics were updated. Guidelines are proposed concerning the monitoring of the drug effects that provide recognition of responders to the therapy and, subsequently, the decision about continuation, switching or discontinuation of a biologic. Furthermore, gaps in the current knowledge and unmet needs were discussed.
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Produtos Biológicos , Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/tratamento farmacológico , Qualidade de Vida , Rinite/tratamento farmacológico , Sinusite/terapia , Produtos Biológicos/uso terapêutico , Doença CrônicaRESUMO
BACKGROUND: Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. METHODS: Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. RESULTS: Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participantsâ™ comments provided insights into caveats of, and disagreements related to, near-consensus items. CONCLUSIONS: Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.
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Obstrução Nasal , Pólipos Nasais , Rinite , Sinusite , Humanos , Consenso , Qualidade de Vida , Técnica Delphi , Rinite/diagnóstico , Sinusite/diagnóstico , Sinusite/terapia , Corticosteroides , Doença Crônica , Pólipos Nasais/diagnósticoRESUMO
Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.
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Hipersensibilidade , Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/diagnóstico , Rinite/terapia , Rinite/epidemiologia , Qualidade de Vida , Sinusite/diagnóstico , Sinusite/terapia , Sinusite/epidemiologia , Doença Crônica , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapiaRESUMO
Endoscopic grading of nasal polyps (NP) is typically a coprimary endpoint in clinical trials evaluating treatments for chronic rhinosinusitis with nasal polyps (CRSwNP). However, a consensus on the most effective way to grade nasal polyps has not been reached. Different scales have been used, hampering the interpretation of data across trials. This review compares the characteristics of NP grading systems used in registration trials for approved NP treatments. These fundamental differences in grading systems make quantitative comparison of outcomes between trials inaccurate and potentially misleading. In lieu of a universal grading system, reporting the baseline distribution of polyp grades (unilateral and/or summed/total grades), as well as changes from baseline over time by baseline grade may help improve interpretability of outcomes and reduce inaccuracy when attempting cross-trial comparisons and making therapeutic decisions.
Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/tratamento farmacológico , Rinite/tratamento farmacológico , Administração Intranasal , Endoscopia , Sinusite/tratamento farmacológico , Doença CrônicaRESUMO
BACKGROUND: Chronic rhinitis (CR) is currently defined as the presence of at least two nasal symptoms for at least 1 hour per day for more than 12 weeks per year. Such definition lacks evidence-based foundation. CR patients are often divided into "runners" and "blockers", although the evidence supporting such subdivision is limited. The aim of the study was to define CR, to estimate its prevalence and the proportion of "runners" and "blockers". METHODS: Cross-sectional, questionnaire-based study in a random sample of participants representing the general population of the Netherlands. RESULTS: The questionnaire was sent to 5000 residents of the Netherlands; the response rate was 27%. CR was defined as at least 1 nasal complaint present for more than 3 weeks per year. The prevalence of CR in the general population was 40%. Participants who would have been excluded by the former CR definition were shown to have a significantly higher VAS compared to the controls. The larger part of CR group was represented by non-allergic rhinitis (NAR): 70% vs 30%. There were 25% "Blockers" and 22% "Runners" in the CR group, whereas more than a half of the CR group could be classified in neither of these subgroups. CONCLUSION: Based on our data, we suggest that the current definition of CR should be revised and propose a new definition: at least one nasal complaint present for at least 3 weeks per year; although future studies are needed to further validate the proposed definition.
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Rinite , Estudos Transversais , Humanos , Países Baixos/epidemiologia , Nariz , Prevalência , Rinite/epidemiologiaRESUMO
We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.
Assuntos
Produtos Biológicos , COVID-19 , Pólipos Nasais , Transtornos do Olfato , Rinite , Sinusite , Produtos Biológicos/uso terapêutico , Doença Crônica , Humanos , Rinite/tratamento farmacológico , SARS-CoV-2 , OlfatoRESUMO
BACKGROUND: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. METHODS: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. RESULTS: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. CONCLUSION: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.
Assuntos
Pólipos Nasais , Exposição Ocupacional , Rinite , Sinusite , Doença Crônica , Estudos Transversais , Endoscopia , Humanos , Pólipos Nasais/complicações , Exposição Ocupacional/efeitos adversos , Rinite/epidemiologiaRESUMO
BACKGROUND: European direct and indirect cost data is missing for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This study was aimed to establish the economic burden of CRSwNP based on a Dutch cohort of patients. METHODS: A cross-sectional study was performed in adult patients with CRSwNP (N=115) to calculate mean annual direct medical costs and indirect costs per patient with CRSwNP. Outpatient visits, general practitioner visits, first aid visits, hospitalisation and patient travel expenses were measured with the iMTA medical consumption questionnaire. Missed workdays (absenteeism) and decreased productivity during paid work (presenteeism) or during daily life were measured with the and the iMTA productivity cost questionnaire. RESULTS: Total direct costs were 1501 per patient/year, primarily due to outpatient department visits and hospitalisation. Indirect costs were 5659 per patient/year, with productivity losses as major cost expense. CONCLUSION: Adult patients with CRSwNP have higher indirect costs than direct costs and this forms a substantial burden to society. Total annual costs of patients with CRSwNP are estimated to be 1,9 billion/year in the Netherlands.
Assuntos
Absenteísmo , Pólipos Nasais , Sinusite , Adulto , Efeitos Psicossociais da Doença , Estudos Transversais , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/economia , Países Baixos , Sinusite/complicações , Sinusite/economia , Sinusite/terapiaRESUMO
BACKGROUND: A debate is ongoing on the role of the extent of sinus surgery in disease control in chronic rhinosinusitis (CRS). The newly developed Amsterdam Classification on Completeness of Endoscopic Sinus Surgery (ACCESS) score provides a way to quantify extent of surgery. This study aimed to validate the ACCESS scoring system and to report its interrater agreement compa- red to the widely used Lund-Mackay (LM) scoring system. METHODOLOGY: Forty hand-picked anonymized computed tomography scans of sinuses of patients with varying pathology and degree of previous sinus surgery were independently scored by six rhinologists. Interrater agreement was determined by the intraclass correlation (ICC) statistic. RESULTS: The interrater agreement of the ACCESS score was excellent, comparable to the LM score. The ACCESS interrater agree- ment was not influenced by degree of opacification or diagnosis. The ACCESS score reliably measured predicted differences induced by sinus surgery. CONCLUSIONS: the ACCESS score is an easy-to-use valid tool to assess extent of sinus surgery with an excellent interrater agree- ment. Further validation in a random group of CRS cases is required.
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Seios Paranasais , Rinite , Sinusite , Doença Crônica , Endoscopia , Humanos , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/cirurgia , Rinite/diagnóstico por imagem , Rinite/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012(1-3). The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings.
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Prestação Integrada de Cuidados de Saúde , Pólipos Nasais/terapia , Rinite/terapia , Sinusite/terapia , Doença Crônica , HumanosRESUMO
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Aguda , Adulto , Criança , Doença Crônica , Humanos , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapiaRESUMO
BACKGROUND: The European Position Papers on Rhinosinusitis from 2005, 2007 and 2012 have had a measurable impact on the way this common condition with high impact on quality of life is managed around the world. EPOS2020 will be the latest iteration of the guideline, addressing new stakeholders and target users, presenting a summary of the latest literature and evolving treatment modalities, and formulating clear recommendations based on all available evidence. METHODOLOGY: Based on the AGREE II framework, this article demonstrates how the EPOS2020 steering group will address six key areas to ensure consistency in quality and presentation of information in the latest rhinosinusitis clinical practice guideline: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; recommendations and applicability; editorial independence. RESULTS: By analysing the guidance from AGREE II, we formulated a detailed development strategy for EPOS2020. We identify new stakeholders and target users and ratify the importance of patient involvement in the latest EPOS guideline. New and expanded areas of research to be addressed are highlighted. We confirm our intention to use mixed methodologies, combining evidence-based medicine with real life studies; when no evidence can be found, use Delphi rounds to achieve clear, inclusive recommendations. We also introduce new concepts for dissemination of the guideline, using Internet and social media to improve accessibility. CONCLUSION: This article is an introduction to the EPOS2020 project, and presents the key goals, core stakeholders, planned methodology and dissemination strategies for the latest version of this influential guideline.