Symptom burden in patients with chronic rhinosinusitis with nasal polyps or global airway disease prior to biologic treatment: a qualitative study of patients' experiences

UNLABELLED: Chronic rhinosinusitis with nasal polyps (CRSwNP), is a prevalent inflammatory airway disease associated with type 2 inflammation. When CRSwNP coexist with asthma, the condition is referred to as global air disease (GAD). People how lives with CRSwNP or GAD often report a high symptom burden, for example persistent nasal obstruction, impaired smell and taste, disturbed sleep, fatigue, and reduced well-being. While these burdens have been quantified through clinical outcomes and patient-reported outcome measures (PROMs), there is limited qualitative research exploring how these peoples experience living with CRSwNP or GAD in their daily lives. The aim of the study was to describe the impact of CRSwNP or GAD on patients' everyday lives before the initiation of biologic treatment.

METHODS: A descriptive qualitative interview study was conducted with 13 patients diagnosed with CRSwNP or GAD. Semi-structured interviews were analyzed using qualitative content analyzed as described by Graneheim and Lundman, resulting in the identification of thematic categories reflecting participants' lived experiences.

RESULTS: Five categories were identified: (1) feeling constantly unwell, like having a chronic cold, describing the persistent sense of ill health; (2) loss of senses disrupting everyday life, illustrating how impaired smell and taste influenced both social and practical activities; (3) illness leading to social isolation and emotional distress, highlighting psychological and relational consequences; (4) dependence on prednisolone-choosing between the lesser of two evils, reflecting the balance between temporary relief and side effects; and (5) Longing for a normal life, expressing high expectations of biologic therapy as a potential turning point.

CONCLUSION: This study showed that patients with CRSwNP or GAD experienced a substantial symptom burden, sensory loss, impaired work ability, and reduced social participation, all of which profoundly affected their daily lives. Many relied on prednisolone for temporary relief despite being aware of its serious side effects. The extensive impact of CRSwNP made participants hopeful that biologic therapy could provide more stable symptom control and help them regain a more "normal" life. CRSwNP or GAD is a multifaceted condition that affects patients' emotional, psychological, and social well-being. These findings highlight the importance of adopting a holistic treatment approach, including consideration of psychosocial support to address the broader consequences of the disease.