Remission: Mission Possible in Chronic Rhinosinusitis with Nasal Polyposis?
Notice bibliographique
Résumé
Remission: Mission Possible in Chronic Rhinosinusitis with Nasal Polyposis?To the Editor,Remission is emerging as the penultimate goal in the management of several chronic diseases. Recent application of these concepts to the management of inflammatory airway disease has promoted the concept of clinical remission, using a “Treat to Target” approach. The concept of remission, now well-established in Rheumatology as well as Gastroenterology (GI), is emerging in Respiratory Medicine with recent publication of definitions of clinical remission for asthma (1). It is interesting to consider whether the disease remission concept might successfully be applied to Otolaryngology-Head and Neck Surgery (OHNS) in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP).In the treatment of asthma, ‘remission’ is defined as the elimination of exacerbations and stabilization of symptoms, with the possibility of normalizing inflammatory markers, which indirectly reflect lung function and inflammation. Guidelines for inflammatory digestive diseases are similar to those in asthma, in terms of their symptomatic endpoints and rigorous control of disease (2). However, for inflammatory bowel disorders unlike in asthma, an additional endoscopic criterion which documents epithelial and mucosal recovery from disease is also included. The nasal endoscope provides similar characterization for the control criteria in CRSwNP, incorporating symptom control signifying clinical remission with endoscopic remission demonstrating normal sinonasal mucosa, which can also incorporate inflammatory markers highlighting biochemical remission.A consensus statement from tertiary Canadian rhinologists has previously combined symptomatic and endoscopic assessments to define success after endoscopic sinus surgery (ESS), with ‘optimal’ results reported as absence of symptoms and normal appearance of the sinus mucosa on sinonasal endoscopy (3). However, it was unclear how frequently this ‘optimal’ outcome could be achieved. An estimate of remission rates in CRS care is now afforded by two recent studies in CRSwNP which employed a clinical endpoint very similar to the remission definition used in GI for inflammatory bowel diseases. The first study, a prospective trial which assessed outcomes after treatment of CRSwNP with endoscopic sinus surgery (4), and the second, a double-blinded, placebo-controlled prospective trial evaluating refractory CRSwNP managed with long-term, low dose azithromycin (5).After ESS, clinical endpoints resembling remission were attained in 50% of all subjects, but with different rates of remission for different populations distinguished by co-morbidities. At four months after surgery, 72% individuals undergoing primary ESS for CRSwNP attained remission, while those with a history of previous surgery showed lesser response, with a 42% remission rate. Asthmatic subjects did considerably worse than non-asthmatic subjects: non-asthmatics attained remission in 60%, while patients with asthma or with aspirin exacerbated respiratory disease (AERD) only showed remission in 23% and 23.5% of cases, respectively. For the azithromycin trial, there was a 54% remission rate overall. Again, asthma was associated with a worse outcome: non-asthmatics had a remission rate of 88%, while asthmatics achieved only 38% remission, and only in 14% of AERD patients. Individuals demonstrating remission were characterized by parameters of epithelial recovery and healing, approaching those of optimal control as suggested for inflammatory digestive diseases (6).Conclusion: Remission is indeed a concept that can be attained in CRSwNP, even in patients who failed previous surgery, as demonstrated by these findings. Some patient groups apparently have more difficult disease evolution, and asthma emerges as an important treatable trait in patients with CRSwNP. Better defining this outcome through consensus-based definitions will allow for the identification and stratification of clinical scenarios where patients have complete relief from their disease symptomatically in addition to biochemical and endoscopic normalization which penultimately achieving remission.Respectfully submitted,Yvonne Chan, Andrew Thamboo, Joseph Han, Martin Desrosiers
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,008 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».