A New Era in Understanding Chronic Rhinosinusitis With Nasal Polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory sinus disease that can present with nasal congestion, discharge, facial pressure and reduced sense of smell and taste.1 This chronic disease is often driven by inflammation in the epithelium, which acts as the first point of contact for everyday environmental irritants like dust and pollen.2-5 This process is driven by key epithelial cytokines, including thymic stromal lymphopoietin (TSLP), IL-25, and IL-33.3-6 These cytokines can drive multiple downstream inflammatory pathways and lead to multiple clinical manifestations, such as polyp formation and/or chronic symptoms.3-8 Understanding these mechanisms opens the door to better understand the condition and can help inform clinical decision making.3,4,8

The Burden on Patients  

CRSwNP is a chronic condition that can significantly impact an individual's daily life, including potential wide-reaching physical and emotional challenges.9 A proportion of CRSwNP patients experience total loss of smell (anosmia).10 This can impact not only the enjoyment of food but also safety, limiting the body’s ability to detect hazards like smoke or gas.11 In addition, CRSwNP often coexists with other respiratory conditions such as asthma and allergic rhinitis.12

Challenges in Managing CRSwNP

Timely referral to the right specialist can make a critical difference in how CRSwNP is diagnosed and managed. According to AAFA’s national survey, 51% of patients experienced significant delays in diagnosis, often because symptoms overlap or were mistaken for asthma or allergies.9 For many, it wasn’t until connecting with an ear, nose and throat (ENT) specialist or allergist that they were able to receive the testing and care needed to better understand and manage their condition.9

Once diagnosed, most patients start with standard treatments like intranasal corticosteroids (INCS) to reduce swelling and improve breathing.9,13,14 Short courses of oral corticosteroids (OCS) are also common for flare-ups, and while these can offer temporary relief, they may not address the root cause of inflammation.15

Some patients may eventually need sinus surgery to remove polyps and improve sinus drainage.16 However, in patients who had surgery, approximately 40% of patients experienced recurrence within a few years post-surgery.17 Biologics are class of medications that aim to target the underlying inflammation.9 By blocking specific inflammatory pathways, biologics may reduce the size and recurrence of nasal polyps.18 While not right for everyone, when added to standard of care, they may help patients with CRSwNP.19

AstraZeneca’s Commitment to CRSwNP Care 

AstraZeneca is helping lead a new chapter in CRSwNP, one focused on targeting key causes of disease. With deep expertise in respiratory and immunology, AstraZeneca is advancing innovative therapies that reflect the complexity of CRSwNP and the real-world needs of patients. Through ongoing research, providing education and close collaboration with the patient community, AstraZeneca is reimagining what effective, personalized care can look like for those living with this often-overlooked chronic condition.

 

References

  1. Stevens WW, Schleimer RP, Kern RC. Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract. 2016;4(4):565–572. doi:10.1016/j.jaip.2016.04.012
  2. Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy. 2016;9:45–53.
  3. Ha J-G, Cho H-J. Unraveling the role of epithelial cells in the development of chronic rhinosinusitis. Int J Mol Sci. 2023;24(18):14229.
  4. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491–1503.
  5. Calvén J, Ax E, Rådinger M. The airway epithelium: a central player in asthma pathogenesis. Int J Mol Sci. 2020;21(23):8907.
  6. Laulajainen-Hongisto A, Toppila-Salmi SK, Luukkainen A, Kern R. Airway epithelial dynamics in allergy and related chronic inflammatory airway diseases. Front Cell Dev Biol. 2020;8:204.
  7. Stevens WW, Peters AT, Tan BK, et al. Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis. J Allergy Clin Immunol Pract. 2019;7(8):2812–2820.e3.
  8. Staudacher AG, Peters AT, Kato A, Stevens WW. Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis. Ann Allergy Asthma Immunol. 2020;124(4):318–325.
  9. Asthma and Allergy Foundation of America. Life with Nasal Polyps Report. Accessed September 15, 2025. https://aafa.org/wp-content/uploads/2024/04/life-with-nasal-polyps-report.pdf
  10. Gavidia M. Improved sense of smell achieved with biologics for CRS With Nasal Polyps, asthma. Am J Manag Care. 2022;May 12.
  11. Luke L, Lee L, Gokani SA, Boak D, Boardman J, Philpott C. Understanding the impact of Chronic Rhinosinusitis with Nasal Polyposis on smell and taste: an international patient experience survey. J Clin Med. 2023;12(16):5367. doi:10.3390/jcm12165367
  12. Chen S, Zhou A, Emmanuel B, Thomas K, Guiang H. Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis. Curr Med Res Opin. 2020;36(11):1897–1911.
  13. Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol. 2018;8(4):461–470. doi:10.1002/alr.22093
  14. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1–464.
  15. Allergy and Asthma Network. Understanding oral corticosteroid side effects. Accessed September 17, 2025. https://allergyasthmanetwork.org/ocs-oral-corticosteroids/understanding-ocs-side-effects/
  16. Manandhar S, Khan SA, Pokharel A, Shah D. Revolutionizing chronic rhinosinusitis treatment with functional endoscopic sinus surgery: Insights from a low-middle income country. Medicine (Baltimore). 2025;104(18):e42382. doi:10.1097/MD.0000000000042382
  17. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127:550–555. doi:10.1002/lary.26391
  18. Bachert C, Zhang N, Cavaliere C, Weiping W, Gevaert E, Krysko O. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020;145(3):725–739. doi:10.1016/j.jaci.2020.01.020
  19. Gomes PL, et al. Biologics for Chronic Rhinosinusitis with Nasal Polyps. AAO-HNS. 2023.