Synopsis
Recognise inflammatory nasal polyps, connect recurrent disease with asthma and NSAID reactions, and apply current medical, surgical and biologic treatment criteria.
- Typical inflammatory polyps cause persistent bilateral blockage, smell loss and rhinorrhoea rather than a short-lived cold.
- Assess asthma, previous sinus operations, steroid exposure and reactions to aspirin or other NSAIDs.
- Aspirin-exacerbated respiratory disease combines chronic polyp disease, asthma and respiratory reactions to aspirin or related NSAIDs.
Key red flags
Do not label a unilateral bleeding nasal mass as benign inflammatory polyps; arrange urgent ENT examination.
Investigation priorities
Confirm polyps and assess objective mucosal disease burden.
Management branches
Typical bilateral inflammatory polyps cause persistent obstruction or smell impairment.
- Start or optimise a suitable intranasal corticosteroid and demonstrate how the preparation should reach the nasal cavity.
- Offer an appropriate saline regimen and check adherence before concluding that topical therapy has failed.
Key medicines
Nasonex mometasone furoate 50 micrograms per actuationFor adult nasal polyposis, begin with two sprays into each nostril once daily, totalling 200 micrograms daily. If control remains inadequate after five to six weeks, increase to two sprays per nostril twice daily, totalling 400 micrograms daily. Re-evaluate if a further five to six weeks produces no improvement.
Dupilumab, Dupixent 300 mg pre-filled syringeFor adult chronic rhinosinusitis with nasal polyps, give an initial 300 mg subcutaneous dose, then 300 mg every other week. Continue intranasal corticosteroids. The UK SmPC advises considering discontinuation if there is no response after twenty-four weeks; partial responders may improve with longer treatment.