Control Status of Chronic Rhinosinusitis in Severe Asthma Patients Receiving Biologics: A Real-World Cross-Sectional Study

Objective: This study aimed to determine the prevalence, subtypes, and control status of chronic rhinosinusitis (CRS) among patients with severe asthma receiving biologic therapy in a tertiary allergy clinic. Methods: A single-center, cross-sectional observational study was conducted in adult patients with severe asthma receiving biologics for at least 6 months. CRS diagnosis and control were assessed based on European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria. The Sinonasal Outcome Test-22 (SNOT-22) was also administered. Statistical analyses were performed using appropriate univariate and multivariate methods. Results: Among 148 patients with severe asthma receiving biologic therapy, 97 (65.5%) were diagnosed with comorbid CRS. Of these, 68 (45.9%) had CRS with nasal polyps (CRSwNP) and 29 (19.5%) had CRS without nasal polyps (CRSsNP). A total of 54 patients (55.6%) were treated with omalizumab and 43 (44.3%) with mepolizumab. Overall, 32.9% of patients had controlled CRS, 36.0% were partly controlled, and 30.9% were uncontrolled. In multivariable ordinal regression analysis, the presence of N-ERD and higher BMI were associated with poorer CRS control, whereas early-onset asthma and prior maintenance systemic corticosteroid use were associated with better control, suggesting that these factors may be related to CRS control status in this population. Conclusions: CRS is highly prevalent among patients with severe asthma receiving biologics, and approximately one-third remain uncontrolled despite treatment. These findings emphasize the importance of regular upper airway assessment and may inform future strategies for optimizing biologic selection and treatment outcomes in this population.