Understand Central Compartment Atopic Disease

PROGRAM DESCRIPTION: Central Compartment Atopic Disease is a recently described subtype of Chronic Rhinosinusitis with Nasal Polyposis. At first, it was noted that some types of polypoid degeneration of the middle turbinate were closely associated with inhalant allergic disease and that some types of more advanced manifestations involving sinonasal polyposis of the entire central nasal cavity were as well. It has now become recognized as its own phenotypic variant of CRSwNP. A specific pattern of endoscopic and computerized tomography findings is associated with CCAD. Given its association with inhalant allergy, it may be that a different approach to treatment may be necessary. This panel of experts will discuss what CCAD is and how it came to be recognized as its own phenotypic entity, the inhalant allergy driving this inflammatory process, and what role surgery and immunotherapy play in its treatment. Could FESS worsen disease progression? Should immunotherapy be used as primary treatment? Would a biologic be the best choice for patients with this subtype?

OUTCOME OBJECTIVE 1: Describe what Central Compartment Atopic Disease is and discuss how it came to be recognized

OUTCOME OBJECTIVE 2: Discuss the pathophysiology of CCAD and its associated medical comorbidities

OUTCOME OBJECTIVE 3: Discuss and debate treatment options for CCAD and if it should be approached differently from other endotypes of CCAD

BACKGROUND STATEMENT: CCAD is a recently recognized phenotypic variant of CCAD which is, to a larger degree, driven by inhalant allergy. This is different from other subtypes of CRSwNP. While one study shows good outcomes for FESS, there is evidence FESS worsens progression, and allergy immunotherapy may play a role.