Assessing Nasal Obstruction Improvement in Dupilumab-Treated Patients With Active Anterior Rhinomanometry: A Preliminary Study.

Objective: To objectively assess nasal flow obstruction improvement through anterior active rhinomanometry (AAR) in patients with severe chronic rhinosinusitis with nasal polyps treated with dupilumab.

Methods: Dupilumab-treated patients were evaluated at baseline (T0), 3rd month (T1) and 6th month (T2) after therapy initiation by AAR, and nasal airway resistances were measured using the Rinopocket ED200 system™. The Lund-Mackay Score (LMS), the Nasal Polyp Score (NPS) and the Lund-Kennedy Score (LKS) were assessed. Also, patients were required to fill in the Nasal Obstruction Symptom Evaluation scale, the 22-Item Sinonasal Outcome Test and the Visual Analogue Scale for sinonasal symptoms.

Results: Twenty-one patients (n = 21) were included. By T1, both inspiratory and expiratory resistances, as well as total nasal resistance, showed a significant reduction. At T2, these improvements were sustained but did not differ significantly from T1. Patient-reported outcomes followed a similar trend, showing marked improvement at T1 but no further significant changes at T2. Conversely, endoscopic and radiologic outcomes (NPS, LKS, LMS) demonstrated significant improvements across all timepoints.

Conclusions: This preliminary study shows the rapid effectiveness of dupilumab in relieving nasal obstruction. Interestingly, while endoscopic and radiologic assessments showed ongoing improvement at each time point, nasal airway resistance measured with AAR did not significantly decrease beyond the initial 3 months of treatment.