Overview

Patients with severe or difficult-to-treat asthma represent a small amount of total asthmatic patients, but weight on the national health system for the costs of disease management. Chronic rhinosinusitis with nasal polyposis, which the Italian severe/uncontrolled asthma registry reported with a prevalence of 30%, represents a comorbidity that significantly impact lung function and asthma control in severe asthma. Recent evidence indicates that there is a consistent heterogeneity regarding mucosal alterations present in subjects with nasal polyposis involving different pathways: inflammatory cells, remodeling, T cell activation, local IgE production, alteration induced by interactions between microorganisms and epithelial cells.

Eligibility

Inclusion Criteria:age >18 years

• diagnosis of severe refractory asthma according to the ERS/ATS criteria ATS
• Blood eosinophils >150 cells/mcL at the screening visit and at least one value of 300 or more eosinophils/mcL during the previous year;
• at least two exacerbations despite maximal therapy with long-acting bronchodilators and high dose inhaled corticosteroids in the previous year or the need for continued therapy with oral corticosteroids in addition to maximal inhaled therapy for at least 6 months in the previous year
• written informed consent.
• For CRSwNP diagnosis, the EPOS 2020 guidelines will be considered as reference. All the above-mentioned inclusion criteria must be met.

Exclusion Criteria:Pregnancy

• Eosinophilic Granulomatosis with Polyangiitis (EGPA);
• Serious life threatening cardiopulmonary disorders;
• Systemic immunologic disorder in the last 12 months;
• Positive history for malignant tumors ever in patient's life;
• Immunodeficiency.