Review outlines approach to neutrophilic inflammation in refractory airway disease

This review examines how clinicians can identify and act on a clinically meaningful neutrophilic treatable trait in corticosteroid-refractory asthma, chronic rhinosinusitis with nasal polyps, and allergic rhinitis. The authors state that neutrophilia can coexist with type 2 inflammation or arise from infection, smoking, obesity, or treatment effects, and should not automatically be equated with a stable non-T2 endotype or corticosteroid resistance; they note no neutrophil-specific biologic is currently approved for these conditions, and trials targeting CXCR1/2 or IL-17 pathways showed that reducing neutrophilic inflammation did not necessarily translate into meaningful clinical benefit. The review proposes a treatable-trait approach integrating direct airway phenotyping (induced sputum or nasal cytology), exclusion of secondary causes, evidence- or trial-based treatment selection, and longitudinal reassessment.

Most relevant for: Patients with difficult-to-control, corticosteroid-refractory asthma, chronic rhinosinusitis with nasal polyps, or allergic rhinitis in whom neutrophilic airway inflammation is suspected.

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