How specialists coordinate care for nasal polyps and asthma

This guide is for allergy and immunology physicians, sinus specialists and practice owners coordinating care for people with asthma and chronic rhinosinusitis with nasal polyps. It offers practical steps for sharing airway history, reviewing treatment paths and tracking response across specialties.

1. Put the upper and lower airways in the same review

Asthma and chronic rhinosinusitis with nasal polyps, or CRSwNP, can share type 2 inflammation. Allergy & Asthma Network says some treatments can help both conditions, and biologic injections targeting that inflammation are given every 2 to 4 weeks. A shared review can keep nasal and asthma symptoms visible when teams discuss what treatment is intended to address.

The network reports that about 88 out of 100 people with asthma show sinus inflammation on imaging, even without obvious sinus symptoms. That figure describes imaging findings, not nasal polyps. The network also says as many as 50 to 70 percent of asthma patients have type 2 inflammation, involving immune cells such as eosinophils, mast cells and T cells.

For a practical handoff, record what each specialty is following. Nasal symptoms, polyp recurrence and asthma control provide distinct points for discussion, even when the conditions may share an inflammatory pathway. Keeping those outcomes together can help the clinicians compare the response across both airways.

2. Check whether the history raises AERD

AERD, also called aspirin-exacerbated respiratory disease, is relevant when asthma and nasal polyps occur alongside breathing or sinus reactions to aspirin or other nonsteroidal anti-inflammatory drugs. McGovern Medical School describes the aspirin triad as nasal polyps, asthma and aspirin intolerance. It notes aspirin can cause skin reactions, asthma symptoms and, in some cases, a life-threatening reaction.

Prevalence estimates describe different groups. Mass General Brigham says AERD affects 9 percent of adults with asthma and up to 40 percent of adults with both asthma and nasal polyps. Allergy & Asthma Network says it affects about 1 in 10 people with nasal polyps. Keep the population attached to each number in staff education and care summaries.

When the history includes a possible medication reaction, the shared record can identify which clinician is assessing it and how that assessment will reach the other team. Patients should discuss symptoms and treatment choices with their own doctor.

3. Make the treatment sequence visible

Allergy & Asthma Network describes a stepwise CRSwNP path. Doctors often begin with daily rinses and nasal sprays. If symptoms do not improve or polyps keep returning, they may consider sinus surgery or biologic medicines, based on symptom severity and recurrence. A shared summary can list the treatments tried, whether polyps returned and the question being considered at the next review.

Recurrence can shape the next discussion, especially for AERD. In an interview on The Allergist podcast, Dr. Yvonne Chan of the University of Toronto described polyp recurrence rates of about 20 to 60 percent among AERD patients and said about 25 percent needed revision surgery within five years of their first operation. These figures describe AERD patients, so keep that group clear when reviewing prior surgery.

A treatment history also helps explain why clinicians may discuss inflammation control alongside procedures. In an Allergy & Asthma Network webinar, an allergist said relying on cycles of prednisone and surgery leaves an 85 percent recurrence rate, and argued for controlling type 2 inflammation. That is the recurrence figure he cited in describing this cycle.

4. Agree how the team will respond to recurrence

Andrew White, speaking in an Allergy & Asthma Network webinar, described a general default of sinus surgery followed by good topical therapy, with a biologic considered if polyps recur. He said clinicians have limited ability to predict early recurrence and described moving to a biologic at recurrence rather than waiting until polyps are extensive. This gives teams a concrete sequence to discuss while reviewing a patient's history.

White also said topical sprays often control disease and that one surgery can provide prolonged benefit for about 20 to 30 percent of patients. Dr. Chan, in the same podcast interview, said about 20 percent of patients with chronic rhinosinusitis or polyps may do well with surgery alone, perhaps once in a lifetime. These estimates describe the speakers' accounts and groups; they underline why a review should include the individual treatment history and response.

For practice owners, turn the sequence into a reliable handoff: include prior rinses and sprays, surgery dates, recurrence, asthma response and the next planned review. The handoff gives allergy and sinus clinicians the same treatment timeline to work from.

5. Connect biologic discussions to both conditions

Biologic choice may matter across the upper and lower airways. A review of studies in AERD found dupilumab was most consistently associated with improvement in upper and lower airway outcomes. The same review reported anti-IL-5 and anti-IL-5 receptor therapies reduced eosinophilia and asthma exacerbations, while their sinonasal benefits varied.

Asthma type is another part of the shared discussion. Allergy & Asthma Network says different types of severe asthma may need different biologics, with some prescribed for allergic asthma and others for eosinophilic asthma. The asthma clinician can bring that information together with the nasal treatment history when teams review options.

A phase III, double-blind, placebo-controlled trial of mepolizumab found reduced polyp size, nasal surgeries and systemic corticosteroid use, alongside improved nasal symptoms and health-related quality of life. Recording which outcomes matter to each specialty can make it easier to review treatment response across conditions.

6. Set a shared point to review response

A practical review can bring together polyp recurrence, nasal symptoms, asthma control and exacerbations. The teams can agree which clinician records each finding and how it reaches the other specialty. This creates a clear place to compare the upper and lower airway outcomes described in biologic studies without assuming that one measure represents the whole response.

Use that review to revisit the documented treatment sequence and the patient's response to it. For an owner, the concrete action is to add a shared asthma and polyp handoff to the allergy and sinus workflow, with the treatment timeline and a planned review point.

This page is general education only. It is not medical advice. Talk with your own doctor about your health.

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