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Airway Disease, Rhinosinusitis CE/CME accredited

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A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation Close

Minimizing the clinical burden of chronic rhinosinusitis with nasal polyposis

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Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the burden of disease of CRSwNP and the importance of early diagnosis
  • Explain the pathophysiology of CRSwNP and how this can guide treatment decisions
  • Summarize the clinical evidence supporting the use of current and emerging treatment options for CRSwNP
Overview

In this activity, ENT specialists Prof. Valerie Lund and Dr Sietze Reitsma discuss the burden of CRSwNP, its underlying pathophysiology, and current and emerging treatment options; their discussion on these themes is based on questions posed by healthcare professionals involved in the care of patients with CRSwNP.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of allergists and immunologists, ENT specialists, pulmonologists and respiratory care specialists, primary care physicians and specialty nurses involved in the management of CRSwNP.

Disclosures

All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty 

Prof. Valerie Lund discloses: Advisory board or panel fees from GlaxoSmithKline, Novartis and Sanofi. Speaker’s bureau fees from Abbott, GlaxoSmithKline, Novartis and Sanofi.

Dr Sietze Reitsma discloses: Advisory board or panel fees from GlaxoSmithKline, Novartis and Sanofi. Consultancy fees from GlaxoSmithKline, Novartis and Sanofi. Grants/research support from GlaxoSmithKline, Novartis and Sanofi. 

Content reviewer

Kayley Wagner, APRN has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Katrina Lester and Christina Mackins-Crabtree have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 1.0 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 1.0 ANCC pharmacotherapeutic contact hour.

Date of original release: 26 April 2022. Date credits expire: 26 April 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

This activity is CE/CME accredited

To obtain the CME credit(s) from this activity, please complete this post-activity test.

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Topics covered in this activity

Airway Disease/ Rhinosinusitis
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touchIN CONVERSATION
Minimizing the clinical burden of chronic rhinosinusitis with nasal polyposis
1.0 CE/CME credit

Question 1/5
Your patient was recently diagnosed with CRSwNP and you want to assess their disease burden. How would you measure the severity of their sinonasal symptoms and the impact of CRSwNP on their disease-specific quality of life?

CRSwNP, chronic rhinosinusitis with nasal polyps; LMS, Lund–Mackay Score; NPS, nasal polyp score; SF-36, 36-item Short Form; SNOT-22, Sino-nasal Outcome Test-22; VAS, visual analogue scale.

The SNOT-22 and VAS are validated tools to assess quality of life and symptom severity, respectively, in patients with CRSwNP. SF-36 is designed to assess general health-related quality of life.1 

The LMS is a validated scoring system of sinonasal inflammatory change using computed-tomography scans.1,2 

The NPS measures the extent of polyps within each nasal cavity, using a scoring system to quantify endoscopy findings.2

Abbreviations

CRSwNP, chronic rhinosinusitis with nasal polyps; LMS, Lund–Mackay Score; NPS, nasal polyp score; SF-36, 36-item Short Form; SNOT-22, Sino-nasal Outcome Test-22; VAS, visual analogue scale.

References

  1. Fokkens WJ, et al. Rhinology. 2020;58(Suppl. S29):1–464.
  2.  Lombardi C, et al. World Allergy Organ J. 2021;14:100592.
Question 2/5
Your patient, a 40-year-old male, has been experiencing symptoms of CRS including nasal obstruction and loss of smell. His primary care physician has prescribed saline rinses and INCS, but there has been no improvement in his symptoms after 12 weeks. Based on the EPOS 2020 care pathway, which of the following next steps should a primary care physician consider?

CRS, chronic rhinosinusitis; ENT, ear, nose and throat; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; IgE, immunoglobulin E; INCS, intranasal corticosteroid spray.

EPOS 2020 recommends that patients with ≥2 symptoms of CRS should be referred to secondary care/an ENT specialist if symptoms have not improved after 6–12 weeks. The care pathway states that antibiotics should be avoided, and oral corticosteroids could be considered as part of AMT by a specialist, once primary diffuse CRS has been diagnosed. Markers of type 2 inflammation, such as IgE and blood eosinophils should be assessed later, after AMT and additional work up.

Abbreviations

AMT, appropriate medical therapy; CRS, chronic rhinosinusitis; ENT, ear, nose and throat; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; IgE, immunoglobulin E.

Reference

Fokkens WJ, et al. Rhinology. 2020;58(Suppl. S29):1–464.

Question 3/5
Which of these statements best reflects the prevalence of CRSwNP endotypes among patients in Eastern Asia?

CRSwNP, chronic rhinosinusitis with nasal polyps

The type 2 endotype, characterized by eosinophilia and type-2 cytokines, is predominant in Western countries, accounting for ~85% of cases of CRSwNP; however, in East Asian countries, the type 2 endotype is found in <50% of patients, but this has increased over recent years.1–3

Abbreviation

CRSwNP, chronic rhinosinusitis with nasal polyps.

References

  1. Kato A, et al. Allergy. 2022;77:812–26.
  2. Cho SW, et al. Asia Pac Allergy. 2017;7:121–30.
  3. Staudacher AG, et al. Ann Allergy Asthma Immunol. 2020;124:318–25.
Question 4/5
EVEREST is the first head-to-head trial assessing the comparative efficacy and safety of two biologics in patients with severe CRSwNP and comorbid asthma. Which two biologics are included in the trial?

CRSwNP, chronic rhinosinusitis with nasal polyps.

EVEREST (NCT04998604) is a phase IV head-to-head trial comparing the efficacy of dupilumab and omalizumab in reducing polyp size and improving sense of smell in patients with severe CRSwNP, as well as evaluating the safety of both biologics. The estimated primary completion date is October 2023.

Abbreviations

CRSwNP, chronic rhinosinusitis with nasal polyps.

Reference

NCT04998604. ClinicalTrials.gov. Available at: https://clinicaltrials.gov/ct2/show/NCT04998604 (accessed 17 March 2022)

Question 5/5
Your patient, a 48-year-old male has severe uncontrolled CRSwNP, with loss of smell and significantly impaired quality of life. He had bilateral endoscopic sinus surgery 2 years ago and complete revision surgery 6 months ago, and has been receiving low dose OCS for 3 months, with little improvement. Tests reveal he has a blood eosinophil count of 352 cells/µL. Based on EPOS 2020 recommendations and currently approved therapies in Europe, how would you further manage this patient?

CRSwNP, chronic rhinosinusitis with nasal polyps; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; OCS, oral corticosteroids.

According to EPOS 2020, patients who have received revision surgery with no improvement after 6–12 weeks can be considered for additional therapy, including treatment with a biologic, if they meet at least three of five criteria. This patient has evidence of type 2 inflammation, significant loss of smell and significantly impaired quality of life. Comorbid asthma and a need for/contraindication to systemic steroids are the other two criteria.

Long-term antibiotics and xylitol rinses are recommended additional therapies for patients with non-type 2 CRSwNP.

Omalizumab, mepolizumab and dupilumab are approved by the EMA and FDA for the treatment of CRSwNP. Tezepelumab is not currently approved by the FDA or EMA for this indication.

Abbreviations

CRSwNP, chronic rhinosinusitis with nasal polyps; EMA, European Medicines Agency; EPOS, European Position Paper on Rhinosinusitis and Nasal Polyps; FDA, US Food and Drug Administration.

Reference

Fokkens WJ, et al. Rhinology. 2020;58(Suppl. S29):1–464.

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