Chronic rhinosinusitis with nasal polyps and asthma: unraveling shared inflammatory pathways and evolving therapeutic synergies

Abstract Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma, as upper and lower respiratory tract co-morbidities, is typically associated with high rates of co-morbidity and synergistic risk of exacerbation, which significantly increases the clinical burden. Studies have shown they share core pathological pathways such as type 2 inflammatory mechanisms, epithelial barrier dysfunction, and microbial-immune interactions. The Unified Airway Theory has guided the development of novel technologies, such as proteomics and single-cell sequencing, which have unveiled the molecular underpinnings of upper and lower airway inflammation, leading to the identification of novel biomarkers and key cellular subpopulations. These advances have established the foundation for precise typing. Current clinical management strategies primarily focus on biologics, complemented by surgical interventions, which significantly improve the prognosis of refractory patients. However, significant gaps persist in the treatment of non-eosinophilic types. The challenges inherent in this field are manifold, including the heterogeneity of diagnostic criteria, mechanisms' complexity, and the side effects. In the future, there is a need to integrate multi-omics technology to improve the typing system, develop non-T2 targeted therapies, optimize the synergistic strategy of biologics and surgery, and improve individualized diagnosis and treatment with the help of artificial intelligence. Through interdisciplinary research to deepen the mechanism knowledge, it is expected to achieve the precise and comprehensive management of nasal polyps combined with asthma and reduce the social health burden.