Long-term outcomes of complex medical rehabilitation of patients with rhinosinusitis with nasal polyposis and comorbidities

Abstract

BACKGROUND: Comparative evaluation of courses of alternating magnetic therapy, low-intensity laser therapy, low-intensity laser radiation and hypoxic training in complex medical rehabilitation of atopic dermatitis and asthma patients with rhinosinusitis with nasal polyposis showed high efficacy of the additional use of physical factors in enhancing the regression of major clinical manifestations of the disease and improving the quality of life.

AIM: The aim of the study was to evaluate the long-term (6, 12, and 18 months) outcomes of complex medical rehabilitation of patients with rhinosinusitis with nasal polyposis, including those with atopic dermatitis and asthma, to assess the preventive potential of instrumental physiotherapy, and to determine the optimal time parameters for retreatment with these therapeutic options.

MATERIALS AND METHODS: Patients were divided into groups with isolated rhinosinusitis (n=90), atopic rhinosinusitis (n=93) or asthma (n=105) according to the severity of rhinosinusitis with nasal polyposis. Each group was in turn randomized into 3 subgroups: the control one, the comparator one, and the experimental one. All subjects received a standard treatment program (endonasal Nasonex, 2 doses twice a day; daily nasal rinsing twice a day). Patients in the comparator subgroups also received dupilumab (300 µg once every 2 weeks); the experimental subgroups received alternating magnetic therapy and low-intensity red laser radiation (633 nm). For atopic dermatitis, narrowband medium wave (311 nm) and broadband long wave (320–400 nm) radiation was added to this treatment program. For asthma, alternating magnetic therapy and low-intensity laser radiation were supplemented with hypoxic interval training.

RESULTS: Positive changes in evaluated clinical parameters were reported in all groups during the entire follow-up period. However, the presence of comorbidities reduced the therapeutic potential of the standard treatment program, according to the results of the long-term observation. The addition of dupilumab significantly improved the condition of patients with isolated rhinosinusitis with nasal polyposis. However, a history of atopic dermatitis and especially asthma reduced the duration of disease remission. The addition of physical factors to the treatment program, pathogenetically justified in the treatment of atopic dermatitis (phototherapy) and asthma (hypoxic training), reliably prolonged the remission period. Complex physiotherapy leads to long-term reduction of pathological correlations, which is manifested by decrease in weight of correlation graphs.

CONCLUSION: The main aim of the follow-up phase of the study was to evaluate the duration of the clinical result achieved, which determines the preventive potential of instrumental physiotherapy techniques, frequency and regularity of physiotherapeutic interventions. Retreatment is recommended after an average of 9–12 months for isolated rhinosinusitis with nasal polyposis and 15–18 months for atopic dermatitis and asthma.

Keywords

rhinosinusitis with nasal polyposis / atopic dermatitis / asthma / dupilumab / low-intensity laser radiation / alternating magnetic therapy / phototherapy / hypoxic training / long-term outcomes

References

[1] Shamkina PA, Krivopalov AA, Ryazantsev SV, et al. Epidemiology of chronic rhinosinusitis. Sovremennye problemy nauki i obrazovaniya. 2019;(3):188–206. EDN: SQILCY

[2] Шамкина П.А., Кривопалов А.А., Рязанцев С.В., и др. Эпидемиология хронических риносинуситов // Современные проблемы науки и образования. 2019. № 3. С. 188–206. EDN: SQILCY

[3] Piskunov GZ, Moiseeva YP. Polyposis rhinosinusitis. Moscow: MEDpress-Inform; 2021. 136 р. (In Russ.)

[4] Пискунов Г.З., Моисеева Ю.П. Полипозный риносинусит. Москва: МЕДпресс-информ, 2021. 136 с.

[5] Morse СJ, Miller C, Senior B. Management of chronic rhinosinusitis with nasal polyposis in the era of biologics. J Asthma Allergy. 2021;14:873–882. EDN: EVFIZJ doi: 10.2147/JAA.S258438

[6] Morse С.J., Miller C., Senior B. Management of chronic rhinosinusitis with nasal polyposis in the era of biologics // J Asthma Allergy. 2021. Vol. 14. P. 873–882. EDN: EVFIZJ doi: 10.2147/JAA.S258438

[7] Pelishenko TG, Kruglova LS, Nagornev SN, Frolkov VK. Comparative assessment of clinical efficacy of different methods of medical rehabilitation in patients with rhinosinusitis polyposa. Physiotherapist = Fiziotherapeutist. 2023;(4):15–24. EDN: LCAOZT doi: 10.33920/med-14-2304-02

[8] Пелишенко Т.Г., Круглова Л.С., Нагорнев С.Н., Фролков В.К. Сравнительная оценка клинической эффективности использования различных методов медицинской реабилитации пациентов с полипозным риносинуситом // Физиотерапевт. 2023. № 4. С. 15–24. EDN: LCAOZT doi: 10.33920/med-14-2304-02

[9] Pelishenko TG, Kruglova LS, Nagornev SN. Features of comprehensive medical rehabilitation ofpatients with polypous rhinosinusitis associated with atopic dermatitis. Russ J Environmental Rehab Med. 2023;(3):14–25. EDN: BHTZND

[10] Пелишенко Т.Г., Круглова Л.С., Нагорнев С.Н. Особенности проведения комплексной медицинской реабилитации пациентов с полипозным риносинуситом, ассоциированным с атопическим дерматитом // Russ J Environmental Rehab Med. 2023. № 3. С. 14–25. EDN: BHTZND

[11] Pelishenko TG. Complex application of therapeutic physical factors in the behaviour of medical rehabilitation of patients with polyposis rhinosinusitis associated with bronchial asthma. Russ J Environmental Rehab Med. 2023;(4):32–39. EDN: ZSEWCW

[12] Пелишенко Т.Г. Комплексное применение лечебных физических факторов при поведении медицинской реабилитации пациентов с полипозным риносинуситом, ассоциированным с бронхиальной астмой // Russ J Environmental Rehab Med. 2023. № 4. С. 32–39. EDN: ZSEWCW

[13] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58 (Suppl. S29):1–464. EDN: THMJZZ doi: 10.4193/Rhin20.600

[14] Fokkens W.J., Lund V.J., Hopkins C., et al. European position paper on rhinosinusitis and nasal polyps 2020 // Rhinology. 2020. Vol. 58, Suppl. S29. P. 1–464. EDN: THMJZZ doi: 10.4193/Rhin20.600

[15] Bachert C, Han JK, Wagenmann M, et al. EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: Definitions and management. J Allergy Clin Immunol. 2021;147(1):29–36. EDN: KNJTUD doi: 10.1016/j.jaci.2020.11.013

[16] Bachert C., Han J.K., Wagenmann M., et al. EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: Definitions and management // J Allergy Clin Immunol. 2021. Vol. 147, N 1. P. 29–36. EDN: KNJTUD doi: 10.1016/j.jaci.2020.11.013

[17] Hanifin M, Rajka N. Diagnostic features of atopic dermatitis. Acta Dermatol Venerol. 1980;92(Suppl):44–47.

[18] Hanifin M., Rajka N. Diagnostic features of atopic dermatitis // Acta Dermatol Venerol. 1980. Vol. 92, Suppl. P. 44–47.

[19] Savvateeva DM, Lopatin VS. Olfactory function in patients with polyposis rhinosinusitis on the background of topical corticosteroid therapy. Rossiyskaya rinologia = Russian Rhinology. 2013;(1):24–27. EDN: TBFCJD

[20] Савватеева Д.М., Лопатин В.С. Обонятельная функция у пациентов с полипозным риносинуситом на фоне топической кортикостероидной терапии // Российская ринология. 2013. № 1. С. 24–27. EDN: TBFCJD

[21] Gorbunov SA, Rusetsky YY, Kudryashov SE, et al. Review of international questionnaires and questionnaires for assessing the quality of life in acute and chronic rhinosinusitis. Rossiyskaya rinologia = Russian Rhinology. 2021;29(2):97–106. doi: 10.17116/rosrino20212902197

[22] Gorbunov S.A., Rusetsky Y.Y., Kudryashov S.E., et al. Review of international questionnaires and questionnaires for assessing the quality of life in acute and chronic rhinosinusitis // Russ Rhinology. 2021. Vol. 29, N 2. P. 97–106. doi: 10.17116/rosrino20212902197

[23] Braid J, Islam L, Gugiu C, et al. Meaningful changes for efficacy outcomes in patients with chronic rhinosinusitis with nasal polyps. World Allergy Organ J. 2023;16(5):100776. EDN: CXAMWQ doi: 10.1016/j.waojou.2023.100776

[24] Braid J., Islam L., Gugiu C., et al. Meaningful changes for efficacy outcomes in patients with chronic rhinosinusitis with nasal polyps // World Allergy Organ J. 2023. Vol. 16, N 5. P. 100776. EDN: CXAMWQ doi: 10.1016/j.waojou.2023.100776

[25] Dejaco D, Riedl D, Huber A, et al. The SNOT-22 factorial structure in European patients with chronic rhinosinusitis: New clinical insights. Eur Arch Otorhinolaryngol. 2019;276(5):1355–1365. EDN: RWJBWS doi: 10.1007/s00405-019-05320-z

[26] Dejaco D., Riedl D., Huber A., et al. The SNOT-22 factorial structure in European patients with chronic rhinosinusitis: New clinical insights // Eur Arch Otorhinolaryngol. 2019. Vol. 276, N 5. P. 1355–1365. EDN: RWJBWS doi: 10.1007/s00405-019-05320-z

[27] Mullol J, Azar A, Buchheit KM, et al. Chronic rhinosinusitis with nasal polyps: Quality of life in the biologics era. J Allergy Clin Immunol Pract. 2022;10(6):1434–1453.e9. EDN: TOGQCB doi: 10.1016/j.jaip.2022.03.002

[28] Mullol J., Azar A., Buchheit K.M., et al. Chronic rhinosinusitis with nasal polyps: Quality of life in the biologics era // J Allergy Clin Immunol Pract. 2022. Vol. 10, N 6. P. 1434–1453.e9. EDN: TOGQCB doi: 10.1016/j.jaip.2022.03.002

[29] Hongbo Y, Thomas CL, Harrison MA, et al. Translating the science of quality of life into practice: What do dermatology life quality index scores mean? J Invest Dermatol. 2005;125(4):659–664. doi: 10.1111/j.0022-202X.2005.23621.x

[30] Hongbo Y., Thomas C.L., Harrison M.A., et al. Translating the science of quality of life into practice: What do dermatology life quality index scores mean? // J Invest Dermatol. 2005. Vol. 125, N 4. Р. 659–664. doi: 10.1111/j.0022-202X.2005.23621.x

[31] Pokidysheva LI, Ignatova IA. Correlative adaptometry and the principal component method in estimation of adaptative opportunities of immune system. System Analysis Control Biomedical Systems. 2011;10(1):152–157. EDN: NDOSQZ

[32] Покидышева Л.И., Игнатова И.А. Корреляционная адаптометрия и метод главных компонент в оценке адаптационных возможностей иммунной системы // Системный анализ и управление в биомедицинских системах. 2011. Т. 10, № 1. С. 152–157. EDN: NDOSQZ

[33] Benkov AA, Nagornyev SN, Frolkov VK, et al. Informativity of the method of correlation adaptometry for assessing the severity of the corrective effect of combined use therapeutic physical factors on the example of metabolic syndrome. Fizioterapiya, bal’neologiya i reabilitatsiya = Russ J Physical Ther Balneother Rehabilitat. 2023;22(1):5–14. EDN: JPHBQI doi: 10.17816/rjpbr401115

[34] Беньков А.А., Нагорнев С.Н., Фролков В.К., и др. Информативность метода корреляционной адаптометрии для оценки выраженности корригирующего эффекта сочетанного применения лечебных физических факторов на примере метаболического синдрома // Физиотерапия, бальнеология, реабилитация. 2023. Т. 22, № 1. С. 5–14. EDN: JPHBQI doi: 10.17816/rjpbr401115

[35] Danilov AA, Mikhailova AA, Edelev DA, Tyan VV. Involutive skin changes in the background metabolic syndrome-prerequisites for the development of complex physiotherapeutic influence (part 2). Russ J Environmental Rehab Med. 2023;(4):40–47. EDN: BLTJKZ

[36] Данилов А.А., Михайлова А.А., Еделев Д.А., Тян В.В. Инволютивные изменения кожи на фоне метаболического синдрома: предпосылки для разработки комплексного физиотерапевтического воздействия (часть II) // Russ J Environmental Rehab Med. 2023. № 4. С. 40–47. EDN: BLTJKZ

[37] Chelombitiko EG, Gusakova EV. Systemic manifestations of post-covid syndrome. Russ J Environmental Rehab Med. 2022;(3):48–60. EDN: ODNJGX

[38] Челомбитько Е.Г., Гусакова Е.В. Системные проявления постковидного синдрома // Russ J Environmental Rehab Med. 2022. № 3. С. 48–60. EDN: ODNJGX

[39] Vatrella A, Fabozzi I, Calabrese C, et al. Dupilumab: A novel treatment for asthma. J Asthma Allergy. 2014;(7):123–130. doi: 10.2147/JAA.S52387

[40] Vatrella A., Fabozzi I., Calabrese C., et al. Dupilumab: A novel treatment for asthma // J Asthma Allergy. 2014. N 7. Р. 123–130. doi: 10.2147/JAA.S52387

[41] Pelishenko TG, Kruglova LS, Nagornyev SN, et al. Comparative assessment of clinical efficacy of different methods of medical rehabilitation in patients with rhinosinusitis polyposa. Physiotherapist = Fiziotherapeutist. 2023;(4):15–24. EDN: LCAOZT doi: 10.33920/med-14-2304-02

[42] Пелишенко Т.Г., Круглова Л.С., Нагорнев С.Н., и др. Сравнительная оценка клинической эффективности использования различных методов медицинской реабилитации пациентов с полипозным риносинуситом // Физиотерапевт. 2023. № 4. С. 15–24. EDN: LCAOZT doi: 10.33920/med-14-2304-02

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