Upper airway and quality of life improvements with dupilumab treatment for severe asthma in the Danish Severe Asthma Registry

<bold>Background:</bold> Dupilumab therapy reduces patient-reported disease burden in severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). However, its impact on specific Sino-Nasal Outcome Test-22 (SNOT-22) domains in severe asthma remains unclear. <bold>Methods:</bold> All adults initiating dupilumab for severe asthma in Denmark were included. SNOT-22 scores and domains were analysed at baseline and 12 months and stratified by CRSwNP, CRSsNP or no CRS comorbidity (doctor-diagnosed). Response was defined as change above the Minimal Clinically Important Difference (MCID) of 9 for SNOT-22 and 2.4-3.9 depending on domain. <bold>Results:</bold> In all, 330 patients (median age 56.5, 45% female) were included. Baseline median SNOT22 was 41, (IQR: 27-54), with significant differences across groups (CRSwNP: 48, CRSsNP: 33, no CRS: 33; p<0.001). For the overall population, psychological and sleep domains showed the highest impairment at baseline. The CRSwNP group had significantly higher rhinologic, extra-nasal rhinologic, ear/face, psychological domain scores than other groups, while sleep domain scores were similar across groups. Overall, 64% improved in SNOT-22 above MCID (CRSwNP: 79%, CRSsNP: 44%, no CRS: 37%). Median SNOT-22 after 12 months was 24 (IQR: 12-34). The largest improvement was seen in the rhinologic domain for the CRSwNP group (70% improved >MCID) and the sleep domain for the CRSsNP/no CRS groups (56% and 48% improved >MCID, respectively). <bold>Conclusions:</bold> In severe asthma, patients report significant improvements in global airway impairment on dupliumab. Also, patients without known CRS report significant improvements in non-rhinologic domains such as psychological wellbeing and sleep.