Table 1 Results of the Delphi survey Section 1: identification of phenotypes
Number | Statement | Median | Appropriateness | Consensus/ round |
|---|---|---|---|---|
1 | Biomarkers associated with type 2 inflammation in patients with severe asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP) are: | |||
1.1 | Tissue eosinophil count (sputum, nasal polyp biopsy, bronchial biopsy) (> 10 cells/HPF) | 9 | Appropriate | Yes/1st |
1.2 | Elevated fractional exhaled nitric oxide (FeNO) (≥ 25–30 ppb) | 8 | Appropriate | Yes/2nd |
1.3 | Positive specific IgE (in serum or by intra-epidermal test or Prick test) | 8 | Appropriate | Yes/2nd |
1.4 | Elevated total serum IgE (≥ 100 IU/ml) | 8 | Appropriate | Yes/2nd |
1.5 | Elevated peripheral blood eosinophil count (> 250 cells/µl) | 8 | Appropriate | Yes/1st |
2 | Cut-off values for the different biomarkers associated with type 2 inflammation are only identified in patients with severe asthma or CRSwNP independently, but not in patients with both diseases. | 7 | Appropriate | No (controversy)/2nd |
3 | Phenotyping type 2 asthma and CRSwNP using a combination of different biomarkers improves diagnostic performance compared to using only one of them. | 9 | Appropriate | Yes/1st |
4 | Currently available biomarkers are insufficient for complete phenotyping of type 2 inflammation as predictive of treatment success. | 8 | Appropriate | Yes/1st |
5 | The high variability of peripheral blood or tissue eosinophilia over time (spontaneously or with treatment, especially with systemic corticosteroids and/or biologics) limits their usefulness in phenotyping patients with suspected type 2 inflammation. | 8 | Appropriate | Yes/1st |
6 | The following biomarkers are associated with increased severity in patients with type 2 asthma and CRSwNP: | |||
6.1 | Elevated total serum IgE | 8 | Appropriate | No (controversy)/2nd |
6.2 | Elevated FeNO | 7 | Appropriate | Yes/2nd |
6.3 | Elevated peripheral blood eosinophil count | 9 | Appropriate | Yes/2nd |
6.4 | Positive specific IgE (skin or blood) | 5 | Uncertain | No (controversy)/2nd |
6.5 | Elevated tissue eosinophil count | 8 | Appropriate | Yes/1st |
7 | The following biomarkers are associated with recurrence after ESS in patients with type 2 severe CRSwNP with or without comorbid asthma: | |||
7.1 | Elevated peripheral blood eosinophil count | 7 | Appropriate | No (controversy)/2nd |
7.2 | Highly elevated tissue eosinophil count (> 50 cells/HPF) | 8 | Appropriate | Yes/1st |
8 | In any patient with severe asthma and potential sinonasal disease, loss of smell should be assessed. | 9 | Appropriate | Yes/1st |