Abstract

Objective. Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and share common underlying pathophysiological mechanisms. This study addresses challenges in the diagnosis and treatment of multimorbid patients with CRSwNP and asthma providing new insights for their management.
Methods. Using a modified Delphi method, a scientific board of 40 Italian clinicians (pulmonologists, allergists/clinical immunologists, and ear, nose, and throat specialists) developed consensus statements regarding the multimorbid patient with severe CRSwNP and asthma and including the disease burden, assessment, treatment and multidisciplinary management of multimorbid patients.
Results. All statements reached consensus. Experts acknowledged the substantial disease burden, the key pathophysiological role of type 2 inflammation in multimorbid patients and the need for multidisciplinary care. The use of biologics represents a highly effective therapeutic opportunity for patients with comorbidities, optimising overall outcomes. Integrated care pathways and regular multidisciplinary reassessment were deemed essential for treatment decisions and improved care in multimorbid patients.
Conclusions. This consensus highlights the value of a multidisciplinary approach for multimorbid CRSwNP and asthma patients, advocating for endotype-driven therapies and standardised pathways in clinical practice.

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Authors

Eugenio De Corso - Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli Hospital IRCCS, Rome, Italy

Adriano Vaghi - Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASST Rhodense, Garbagnate Milanese (MI), Italy

Marco Corbò - Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli Hospital IRCCS, Rome, Italy. Corresponding author - marco.corbo@guest.policlinicogemelli.it

Carlotta Pipolo - Otorhinolaryngology Unit, Head and Neck Department, ASST Santi Paolo e Carlo Hospital, Milan, Italy

Alessandra Vultaggio - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Immunoallergology Unit, Careggi University Hospital, Florence, Italy

Andrea Matucci - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Immunoallergology Unit, Careggi University Hospital, Florence, Italy

Elena Cantone - Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, Naples, Italy

Gianenrico Senna - Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy

Marco Caminati - Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy

Frank Rikki Canevari - Department 1 DISC, Otorhinolaryngology Unit, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy

Carlo Lombardi - Departmental Unit of Allergology, Clinical Immunology & Pneumology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy

Aikaterini Detoraki - Department of Internal Medicine and Clinical Complexities, Azienda Ospedaliera Universitaria Federico II, Naples, Italy

Giorgio Walter Canonica - Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy

Jan Walter Schroeder - Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Maria D'Amato - UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Naples, Italy

Maria Angiola Crivellaro - Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy

Matteo Gelardi - Unit of Otolaryngology, University of Foggia, Foggia, Italy

Francesco Antonio Salzano - Unit of Otolaryngology, University Hospital “San Giovanni di Dio e Ruggi, D’Aragona”, Salerno, Italy

Davide Mattavelli - Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

Vittorio Rampinelli - Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

Alberto Macchi - ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy

Ernesto Pasquini - ENT Unit, Azienda USL di Bologna, Ospedale Bellaria, Bologna, Italy

Manuele Casale - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy

Stefania Gallo - ENT Clinic ASST Settelaghi, Head and Neck Research Foresic Center, Insubria University, Varese, Italy

Girolamo Pelaia - Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy

Claudia Crimi - Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Policlinico “G. Rodolico - San Marco” University Hospital, Catania, Italy

Giovanna Elisiana Carpagnano - Institute of Respiratory Diseases, Department DIBRAIN, University of Medicine, Bari, Italy

Enrico Heffler - Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

Eustachio Nettis - Regional Reference Center for Allergic and Immunological Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy

Maria Beatrice Bilò - DISCLIMO, Università Politecnica delle Marche, Italy; Allergy Unit, Department of Internal Medicine, University Hospital AOU Delle Marche, Ancona, Italy

Veronica Seccia - Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy

Giancarlo Ottaviano - Department of Neurosciences, Section of Otolaryngology, University of Padua, Padua, Italy

Claudio Micheletto - Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy

Stefano Del Giacco - Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy

Cristiano Caruso - UOSD Allergology and Clinical Immunology, Department of Abdominal and Endocrine-Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Diego Bagnasco - Section of Respiratory Diseases and Allergology - Department of Internal Medicine (DIMI), University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy

Matteo Bonini - Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy

Francesco Menzella - Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy

Giulio Cesare Passali - Unit of Otorhinolaryngology and Head-Neck Surgery, “A. Gemelli” Hospital Foundation IRCCS, Rome, Italy

Giandomenico Maggiore - Department of Otolaryngology, AOU Careggi, Florence, Italy

Fabiano Di Marco - Respiratory Medicine Unit, ASST Papa Giovanni XXIII, Bergamo; Health Science Department, University of Milan

Francesco Maria Passali - ENT Department, University Tor Vergata, Rome, Italy

Loreta Di Michele - Department of Pulmonary Interstitial Diseases, San Camillo Forlanini Hospital, Rome, Italy

Giampietro Ricci - Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy

Jacopo Galli - Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli Hospital IRCCS, Rome, Italy. *JG and FP shared the co-senior authorship of the article.

Fabio Pagella - Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; IRCCS Policlinico San Matteo, Pavia, Italy. *JG and FP shared the co-senior authorship of the article.

How to Cite
De Corso, E., Vaghi, A., Corbò, M., Pipolo, C., Vultaggio, A., Matucci, A., Cantone, E., Senna, G., Caminati, M., Canevari, F. R., Lombardi, C., Detoraki, A., Canonica, G. W., Schroeder, J. W., D’Amato, M., Crivellaro, M. A., Gelardi, M., Salzano, F. A., Mattavelli, D., Rampinelli, V., Macchi, A., Pasquini, E., Casale, M., Gallo, S., Pelaia, G., Crimi, C., Carpagnano, G. E., Heffler, E., Nettis, E., Bilò, M. B., Seccia, V., Ottaviano, G., Micheletto, C., Del Giacco, S., Caruso, C., Bagnasco, D., Bonini, M., Menzella, F., Passali, G. C., Maggiore, G., Di Marco, F., Passali, F. M., Di Michele, L., Ricci, G., Galli, J., & Pagella, F. (2025). Optimising care for chronic rhinosinusitis with nasal polyps and asthma in multimorbid patients: a multidisciplinary Delphi consensus. ACTA Otorhinolaryngologica Italica, 45(5), 339–348. https://doi.org/10.14639/0392-100X-A973
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