Table 2 Results of the Delphi survey Section 2: treatment

1

There is a need to evaluate a combination of parameters including clinical variables and biomarkers to predict treatment response in patients with severe asthma and CRSwNP with underlying type 2 inflammation endotype.

9

Appropriate

Yes/1st

2

The multimorbidity of several respiratory diseases with type 2 inflammation (asthma plus CRSwNP) in a patient is a risk factor for severity and failure of medical or surgical treatment.

9

Appropriate

Yes/1st

3

In patients with severe type 2 CRSwNP and asthma who have an indication for biologics, the use of anti-IL-4/IL-13 or anti-IgE is independent of the presence of allergy.

8

Appropriate

Yes/1st

4

In patients with both diseases, an indication for a biologic should be made whenever it meets the established indication criteria for either severe type 2 CRSwNP or asthma.

8

Appropriate

Yes/1st

5

A history of previous ESS or its contraindication in patients with type 2 CRSwNP (severe) and asthma supports prescription of the biologic.

8.5

Appropriate

Yes/1st

6

In patients with type 2 CRSwNP (severe) and asthma undergoing ESS, the introduction of biologics should not be delayed in the absence of response to appropriate medical-surgical treatment.

8

Appropriate

Yes/1st

7

In patients with type 2 CRSwNP (severe) and asthma, it is preferable to start the biologic before ESS.

5

Uncertain

No (controversy)/2nd

8

The combination of two biologics with different mechanisms of action may be necessary in patients with severe type 2 asthma and CRSwNP who have not achieved symptom control of any of the diseases with appropriate medical-surgical treatment and the use of a single biologic.

8

Appropriate

Yes/1st

9

The need for short courses of systemic corticosteroids (< 2/year) in patients with severe type 2 asthma and CRSwNP who have not achieved control of any of the diseases with biologics should not be considered as failure if response criteria are met in the disease for which it was indicated.

7

Appropriate

Yes/2nd

10

The combination of two biologics for type 2 inflammation in patients with severe asthma and CRSwNP is not advisable due to cost-effectiveness and/or lack of safety evidence, so it is better to switch to another biologic with a different mechanism of action.

8

Appropriate

Yes/2nd

11

Calculation of the cumulative annual systemic corticosteroid dose in a patient with severe type 2 asthma and CRSwNP should take into account the doses of corticosteroids administered for both asthma and CRSwNP.

9

Appropriate

Yes/1st

12

In patients with severe type 2 asthma and CRSwNP with no response to a biologic treatment (indicated for asthma) in the asthma variables, it is advisable to switch to another biologic with a different mechanism of action, even if there is improvement in the variables associated with sinonasal pathology.

8

Appropriate

Yes/2nd

13

In patients with severe type 2 asthma and CRSwNP with no response to a biologic treatment (indicated for CRSwNP) in the CRSwNP variables, it is advisable to switch to another biologic with a different mechanism of action, even if there is improvement in the variables associated with asthma.

7

Appropriate

Yes/2nd

14

In patients with severe type 2 asthma and CRSwNP with no response to biologic therapy in the CRSwNP variables, it is recommended to:

14.1

Perform ESS even if there is improvement in asthma-associated variables.

8

Appropriate

Yes/1st

14.2

Switch to another biologic.

9

Appropriate

Yes/2nd

15

In patients with severe type 2 asthma and CRSwNP who have a good initial response to a biologic in either condition, it is advisable to extend maintenance treatment for at least 6 months before considering withdrawal or switching to another biologic.

8.5

Appropriate

Yes/1st

16

In patients with type 2 CRSwNP (severe) and asthma, the indication for treatment with biologics should take into account clinical markers of loss of smell (VAS) and quality of life (SNOT-22).

9

Appropriate

Yes/1st