OBJECTIVES

: To identify and characterize adult patients diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) at Maccabi Health Services (MHS).

METHODS

: All data was extracted from the MHS database containing patient's electronic medical records. Diagnoses were identified using ICD-9 and internal MHS codes. Chi-square and Fisher's Exact Tests were used to compare patient characteristics among the populations with and without asthma.

RESULTS

: Through December 31st, 2019, 17,155 patients were identified as having ≥1 diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP) from either an ENT (n=16,974; 98.9%) or allergist specialist (n=181; 1.1%) at MHS. The overall prevalence of CRSwNP at Maccabi is 1.15%. Mean age at first diagnosis of CRSwNP was 46.5 years (SD 14.6) and 60.7% of patients were male. Among the total study population, 4,940 (28.8%) patients were diagnosed with asthma and 12.2% of all patients smoked ever. A higher prevalence of COPD (26.7%) and T2 inflammation related comorbidities AR (88.1%) and AD (18.2%) were observed among the asthma comorbid group. Among patients with available biomarkers, over 50% of patients had eosinophil levels ≥250/μL or IgE levels ≥100 with a greater prevalence among asthma comorbid patients. Patients diagnosed with CRSwNP and asthma generally had more FESS procedures ever through 2018 and in 2019 alone with a greater amount of time between their last two FESS procedures. Among asthma comorbid patients, 68.2% purchased asthma inhalation treatments and 12.2% purchased intranasal corticosteroids in 2019. Less than 1% of patients used Anti-IgE and Anti-IL-5 biologics and only two patients used Anti-IL-4Rα biologics.

CONCLUSIONS

: Repeated FESS procedures, high prevalence of T2 related comorbidities, and long-term use of corticosteroids suggests poor management of CRSwNP requiring new and advanced treatment options. An integrated therapeutic approach which targets the underlying T2 inflammation should be considered for the treatment of these patients.