Long-term outcomes of complex medical rehabilitation of patients with rhinosinusitis with nasal polyposis and comorbidities

BACKGROUND: Comparative evaluation of courses of alternating magnetic therapy, low-intensity laser therapy, low-intensity laser radiation and hypoxic training in complex medical rehabilitation of atopic dermatitis and asthma patients with rhinosinusitis with nasal polyposis showed high efficacy of the additional use of physical factors in enhancing the regression of major clinical manifestations of the disease and improving the quality of life. AIM: The aim of the study was to evaluate the long-term (6, 12, and 18 months) outcomes of complex medical rehabilitation of patients with rhinosinusitis with nasal polyposis, including those with atopic dermatitis and asthma, to assess the preventive potential of instrumental physiotherapy, and to determine the optimal time parameters for retreatment with these therapeutic options. MATERIALS AND METHODS: Patients were divided into groups with isolated rhinosinusitis (n=90), atopic rhinosinusitis (n=93) or asthma (n=105) according to the severity of rhinosinusitis with nasal polyposis. Each group was in turn randomized into 3 subgroups: the control one, the comparator one, and the experimental one. All subjects received a standard treatment program (endonasal Nasonex, 2 doses twice a day; daily nasal rinsing twice a day). Patients in the comparator subgroups also received dupilumab (300 µg once every 2 weeks); the experimental subgroups received alternating magnetic therapy and low-intensity red laser radiation (633 nm). For atopic dermatitis, narrowband medium wave (311 nm) and broadband long wave (320–400 nm) radiation was added to this treatment program. For asthma, alternating magnetic therapy and low-intensity laser radiation were supplemented with hypoxic interval training. RESULTS: Positive changes in evaluated clinical parameters were reported in all groups during the entire follow-up period. However, the presence of comorbidities reduced the therapeutic potential of the standard treatment program, according to the results of the long-term observation. The addition of dupilumab significantly improved the condition of patients with isolated rhinosinusitis with nasal polyposis. However, a history of atopic dermatitis and especially asthma reduced the duration of disease remission. The addition of physical factors to the treatment program, pathogenetically justified in the treatment of atopic dermatitis (phototherapy) and asthma (hypoxic training), reliably prolonged the remission period. Complex physiotherapy leads to long-term reduction of pathological correlations, which is manifested by decrease in weight of correlation graphs. CONCLUSION: The main aim of the follow-up phase of the study was to evaluate the duration of the clinical result achieved, which determines the preventive potential of instrumental physiotherapy techniques, frequency and regularity of physiotherapeutic interventions. Retreatment is recommended after an average of 9–12 months for isolated rhinosinusitis with nasal polyposis and 15–18 months for atopic dermatitis and asthma.