Asthmatic's nasal polyps persist despite surgery
Dear Dr. Roach: I have suffered from asthma and nasal polyps for more than 20 years. The asthma is controlled, and I mention it only because it might have some connection with my polyps. The polyps get so bad that both sides of my nose are blocked, and I have to breathe through my mouth. It is miserable. I have had three surgeries to remove polyps over the past 20 or so years, which involves a trip to the hospital and anesthesia. They always grow back. My current ENT now removes them in an office procedure. While not fun, it gets the job done, and it is preferable to not being able to breathe through my nose. Unfortunately, they grow back within a year.
My ENT has mentioned the drug Dupixent as a possible solution. I have researched it and see that it has to be injected every two weeks. I am not sure I want to go that route, but I would like more information before I make a decision.
Can you give me your thoughts on this drug and whether you would recommend it for someone with my condition? -- J.G.
Answer: Asthma and nasal polyps frequently occur at the same time, sometimes called "united airway disease." When combined with aspirin sensitivity, it has the eponym "Samter's triad," or "aspirin-exacerbated respiratory disease." In any given person, either the asthma or the nasal symptoms may be more problematic.
Standard treatment for nasal polyps includes tobacco cessation, if appropriate. If specific allergens can be identified, they can be avoided as much as possible. However, medications like nasal saline and steroids, along with other medications, sometimes including antibiotics, are usually required for symptom relief. If medicines don't work, surgery is often tried. But surgery by itself isn't a cure; the medications need to continue.
People with polyps that grow back have a new option in medications that block a pro-inflammatory protein called interleukin-4. "Interleukin" means "between white (cells)," as this molecule is a means by which inflammatory cells communicate with each other. Dupilumab (the ending "-mab" always means a monoclonal antibody, which must be injected; this one is generic for and the brand-name Dupixent) is among the most effective of these and has been proven to improve allergic asthma as well as reduce nasal congestion and obstruction in people with nasal polyps. The major side effects were pain at the injection site and conjunctivitis (caused by inflammation, not infection). Conjunctivitis was sometimes so bad that people needed to stop therapy. This was especially true in people with allergic skin disease.
As a generalist, I treat chronic sinus disease routinely, but your symptoms clearly need an expert. Your expert is recommending a drug that is both pretty safe and moderately effective, and I would recommend a trial of the medication to most people in your situation.
Dear Dr. Roach: Your recent articles on the benefits of coffee recommended skipping the cream and sugar. Is your point to skip the cream and sugar because there is no added benefit, or does the cream and sugar negate some of the benefits of the coffee? -- B.S.
Answer: Cream is high in saturated fat, which is probably not good for you, and excess sugar is likewise not a healthy option. If you like a little in your coffee, enjoy it. Just don't be like the guy I saw recently who asked for 14 sugars for his coffee.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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