| Background: A heterogeneous disorder,asthma,is characterized by persistent inflammation of the airways and an overactive reaction.Its pathogenesis is very complex and closely related to the activation of type 2 inflammatory pathways.In recent years,studies have found that the pathogenesis of chronic sinusitis is also closely related to the activation of type 2 inflammatory pathways,and the pathogenesis and development process of both are worthy of induction and study.Objective:To assess the effectiveness of dupilumab in treating bronchial asthma,both with and without chronic rhinosinusitis,in China,and to supply guidance for immunotherapy approaches for type 2 inflammatory diseases.Methods: Subjects with asthma combined with chronic sinusitis admitted to the Department of Allergy,The First Affiliated Hospital of Guangzhou Medical University from January 2021 to December 2022 were enrolled and their treatment class was defined according to the guidelines recommended by the Global Bronchial Asthma Initiative.Subjects with asthma class 4 or 5(severe asthma)before dupilumab treatment were included.Then,the medical history and basic data of subjects with asthma complicated with chronic sinusitis were collected,and all indexes were recorded before and 6 months after dupilumab treatment.These included asthma symptom score,rhinosinusitis symptom score,laboratory tests(absolute and percentage of eosinophils,total Ig E,s Ig E house dust mite quantitation and grading level,s Ig E dust mite quantitation and grading level),lung function,fractional exhaled nitric oxide,and medication dosage(inhaled corticosteroids,long-acting β2-adrenoceptor agonists,leukotriene receptor antagonist,oral corticosteroids,theophylline,nasal spray).Nonparametric Wilcoxon rank sum test and median were used to analyze the changes before and after treatment.Results:Twenty-two eligible subjects were successfully enrolled in this study.All22 subjects were severely asthmatic patients,and all met the diagnosis of asthma combined with chronic rhinosinusitis.In the nonparametric Wilcoxon rank sum test,there was no statistically significant difference between Eos and Eos% before and after treatment(P=0.513,P=0.314,respectively).Other indicators,such as laboratory tests(TIg E,s Ig E house dust mite quantitative and grading level,s Ig E dust mite quantitative and grading level,lung function(FEV1,FEV1%pred,FVC,FEV1/FVC,FEF25-75,FEF50,FEF75),Fe NO,asthma symptom score(ACTs,AQLQs),rhinosinusitis symptom score(VASs,L-Ms)and medication dosage(ICS,LABA,LTRA,OCS,theophylline,nasal spray)before and after treatment were statistically significant(P <0.05).Compared with the median of all indexes before and after treatment except Eos and Eos%,it was found that all indexes were improved to some extent after treatment.Symptom score: asthma--ACT increased from 18 to 21.5,AQLQ from 161.5 to 189;rhinoinusitis--VAS decreased from 7 to 3,L-M decreased from 15 to 10.In laboratory tests,TIg E(k U/L)decreased from 257 to 85.3;The s Ig E house dust mite concentration(k U/L)decreased from 0.275 to 0.115.The s Ig E mite quantification(k U/L)decreased from 0.230 to 0.08.Fe NO and lung function: Fe NO(ppb)decreased from 62 to 30;FEV1(L)increased from 1.635 to 2.295;FEV1% pred increased from 64.75% to84.25%,FVC(L)increased from 3.03 to 3.31,FEV1/FVC increased from 61.91% to69.96%,FEF25-75(L/s)increased from 0.735 to 1.49,FEF50(L/s)increased from1.015 to 1.95,and FEF75(L/s)increased from 0.29 to 0.55.The dosage of ICS(ug)was reduced from 570 to 285,LABA(ug)100 to 50,LTRA(mg)from 10 to 5,OCS(mg)from 12.5 to 5,theophylline(mg)from 600 to 300,and nasal spray(ug)from 256 to 128.Conclusion: In addition to Eos and Eos%,dupilumab improved symptoms,type2 inflammatory markers(Fe NO,TIg E),s Ig E quantification,lung function,sinus imaging findings,and medication dosage reduction in patients with asthma and chronic rhinosinusitis to some extent. |
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