Symptom burden in patients with chronic rhinosinusitis and comorbid asthma prior to biologic treatment: A qualitative study of patients' experiencesRevised title: Symptom burden in patients with chronic rhinosinusitis with nasal polyps or GAD prior to biologic treatment: A qualitative study of patients' experiences

Christiane Haase^1*Lene Munch²Vibeke Backer¹Bente Appel Esbensen³

• ¹Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
• ²Professionshojskolen Absalon - Campus Roskilde, Roskilde, Denmark
• ³Copenhagen Center for Arthritis Research, Glostrup, Denmark

Abstract:Chronic rhinosinusitis with nasal polyps (CRSwNP), with or without comorbid asthma, is a prevalent inflammatory airway disease associated with type 2 inflammation. People with CRSwNP and asthma often report a high symptom burden, for example persistent nasal obstruction, impaired smell and taste, disturbed sleep, fatigue, and reduced well-being. While these burdens have been quantified through clinical outcomes and patient-reported outcome measures (PROMs), there is limited qualitative research exploring how people experience living with CRSwNP in their daily lives. The aim of the study was to describe the impact of CRSwNP, with or without comorbid asthma, on pa-tients' everyday lives before the initiation of biologic treatment. Methods: A descriptive qualitative interview study was conducted with 13 patients diagnosed with CRSwNP. Semi-structured interviews were analyzed using qualitative content analysis as described by Graneheim and Lundman, resulting in the identification of thematic categories reflecting partici-pants' lived experiences. Results: Five categories were identified: (1) Feeling constantly unwell, like having a chronic cold, de-scribing the persistent sense of ill health; (2) Loss of senses disrupting everyday life, illustrating how impaired smell and taste influenced both social and practical activities; (3) Illness leading to social isolation and emotional distress, highlighting psychological and relational consequences; (4) Dependence on prednisolone—choosing between the lesser of two evils, reflecting the balance between temporary relief and side effects; and (5) Longing for a normal life, expressing high expectations of biologic therapy as a potential turning point. Conclusion: This study showed that patients with CRSwNP, with or without comorbid asthma, experienced a substantial symptom burden, sensory loss, impaired work ability, and reduced social participation, all of which profoundly affected their daily lives. Many relied on prednisolone for temporary relief despite being aware of its serious side effects. The extensive impact of CRSwNP made partici-pants hopeful that biologic therapy could provide more stable symptom control and help them regain a more "normal" life. CRSwNP with comorbid asthma is a multifaceted condition that affects pa-tients' emotional, psychological, and social well-being. These findings highlight the importance of adopting a holistic treatment approach, including consideration of psychosocial support to address the broader consequences of the disease