Are there any specific investigations I should consider for patients with nasal polyps who have associated asthma or allergic rhinitis?

For patients presenting with nasal polyps alongside asthma or allergic rhinitis, specific investigations should focus on confirming and characterising the associated airway diseases to guide integrated management. Initial assessment should include spirometry and peak expiratory flow measurement to evaluate asthma control and severity, as recommended by NICE asthma guidelines NICE NG245. Additionally, allergy testing such as skin prick tests or specific IgE blood tests can help identify relevant allergens contributing to allergic rhinitis and potentially exacerbating nasal polyps NICE CG116. Nasal endoscopy or imaging (e.g., CT scan of the sinuses) may be warranted to assess the extent of nasal polyposis and sinus involvement, which is important for both diagnosis and treatment planning NICE CG116. Recent literature highlights the importance of recognising the unified airway concept, where upper and lower airway inflammation coexist, suggesting that comprehensive evaluation of both nasal and bronchial symptoms is critical Marseglia et al. 2011. Furthermore, biomarkers such as blood eosinophil counts and fractional exhaled nitric oxide (FeNO) may provide additional information on type 2 inflammation, which is common in patients with nasal polyps, asthma, and allergic rhinitis, and can guide targeted therapies like biologics Terzakis & Georgalas 2017Peters et al. 2023. In summary, investigations should integrate respiratory function tests, allergy assessment, nasal examination/imaging, and inflammatory biomarkers to fully characterise the patient’s condition and optimise management NICE CG116,NICE NG245 Marseglia et al. 2011Terzakis & Georgalas 2017Peters et al. 2023.