Biologicals: How can they treat severe chronic upper airways diseases (SCUAD)?
Severe chronic upper airways diseases (SCUAD) can be a substantial impairment for the patients’ quality of life. In search of effective therapies, scientists have focused on biologicals, monoclonal antibodies, as a possible therapeutic option, which were very successful in treating severe asthma and chronic spontaneous urticaria. But will biologicals also be able to help SCUAD-patients? MeinAllergiePortal spoke with Prof. Joaquim Mullol, Director, Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic – IDIBAPS, Barcelona, Catalonia, Spain about his research activities on biologicals and monoclonal antibodies and how they can help patients with severe chronic upper airways diseases (SCUAD).
Prof. Mullol, what is the definition of “chronic upper airways diseases“ (SCUAD) and which diseases belong into this category?
Severe chronic upper airways diseases (SCUAD) is the term used for diseases affecting the nose and the paranasal sinuses which are severe, chronic and do not respond to treatment. It does not matter whether those chronic upper airways diseases are allergic or non-allergic.
One important characteristic is: SCUAD-patients do not respond to regular treatment recommended by international guidelines like ARIA (Allergic Rhinitis and its Impact on Asthma) or EPOS (European position paper on rhinosinusitis and nasal polyps). This means, that the symptoms of those patients are not well controlled and remain severe even after treatment.
Chronic upper airways diseases are inflammatory diseases such as severe chronic rhinosinusitis, severe allergic rhinitis, nasal polyposis and Samter’s triad (AERS or Aspirin Exacerbated Respiratory Disease). Severe chronic rhinosinusitis is most common amongst SCUAD patients. Samter’s triad is a distinct phenotype of chronic rhinosinusitis and one of the most severe phenotypes of chronic rhinosinusitis with nasal polyposis.
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How many patients are affected by severe chronic upper airways diseases (SCUAD)?
Depending on the study, one estimates that between 10 and 40 percent of the patients that come to a doctor or hospital are potentially SCUAD-patients. But: One has to keep in mind thatonly a fraction of all patients with upper airways diseases will seek medical help. Patients with only mild symptoms of rhinosinusitis or allergic rhinitis will not go to see a doctor. Those patients will usually ask a pharmacist for help or simply treat themselves.
Are there risk factors for becoming a SCUAD-patient?
There are several risk factors for becoming a SCUAD-patient. For example, for chronic rhinosinusitis, age is a risk factor and for Samter’s triad, female gender is a risk factor.
But one of the most important risk factors for developing severe chronic upper airways diseases is having lower airway diseases in association.
Another risk factor is the patient’s non-compliance, which means that, for example, the patient is taking the medication either in a lower dose than prescribed or irregularly. One reason for non-compliance is corticophobia. Some patients (and some doctors) are simply afraid of possible side effects of topical corticosteroids.
Also smoking could be a risk factor for chronic rhinosinusitis and SCUAD.