The clinical relationship of nasal polyps to asthma

From a meta-analysis on the clinical related literature on asthma and nasal polyps, it was found that patients with asthma had polyps in 7 to 15% with the highest frequency in the age group above 50 years. Between 36% and 96% of acetylsalicylic acid (ASA) intolerant patients had polyps. Patients with nasal polyps had asthma at an average of 29.9% in those referred to ENT departments, and more than 70% in those referred to allergy departments. An average of 12.8% had ASA intolerance. Male to female ratio showed a tendency toward lower values in the series, with the highest frequency of asthma and ASA intolerance. Not all polyp patients had an associated lower airway disease, neither as manifest asthma, nor as hypereactive airways on challenge test. Females with polyps were more likely to have asthma than males. Patients with polyps, asthma, and ASA intolerance showed a later onset of both asthma and polyps compared to those without these characteristics. Asthma developed before polyps in an average of 69% of the series. Most patients showed improvement or at the least were unchanged in the control of their asthma after surgery. Bronchospasm during endonasal surgery was observed in less than 2%. Active asthma before treatment and surgery under local anaesthesia have been factors considered important. Control of polyps and sinus disease showed a poorer outcome in patients with asthma, and this was even more pronounced in patients having ASA intolerance. This survey supports the belief that the eosinophilic nasal polyp patients includes patients with different aetiopathogenetic factors and with different clinical outcomes regarding both the upper and lower airways. Identification of such entities is still needed through basic and clinical research to improve treatment.