Categorizing Nasal Polyps by Severity and Controller Therapy

Objective: To analyze a new categorization of chronic rhinosinusitis with nasal polyposis (CRSwNP) according to severity and controller therapy, modified from the 2007 stepwise treatment for asthma.

Design: Prospective categorization of 50 new or established patients over a 3-month period.

Setting: Tertiary center of Hôtel-Dieu de France Hospital, Beirut, Lebanon.

Patients: Fifty consecutive adult patients with nasal polyposis referred by primary care physicians for sinonasal complaints or by pulmonologists for worsening lower airway control including asthma.

Interventions: All patients were categorized according to CRSwNP severity scale and treated with stepwise therapy based on the study schematic.

Main Outcome Measures: The Modified Sinonasal Questionnaire and the visual analog scale were used to assess patients' response to the treatment regimen and to modify the severity scale and the step treatment accordingly.

Results: Ten new medication-naïve patients with CRSwNP were categorized by severity, which directed the subsequent treatment plan. All patients showed improvement in severity with the stepwise treatment plan. Thirty-seven of 40 patients with established CRSwNP seen in follow-up were easily categorized by degree of control, and subsequent treatment directed by therapy guidelines resulted in improvement.

Conclusions: Initial categorization of medication-naïve patients with CRSwNP and patients with established CRSwNP facilitated delivery of successful directed stepwise therapy that resulted in improvement of classification of severity in most patients. This proposed classification may provide a useful template for future studies comparing patients with CRSwNP.