OverSEA: European Delphi consensus study on best practices for patients with Severe Eosinophilic Asthma and comorbid CRSwNP

Background: Severe asthma with an eosinophilic phenotype (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP) often co-exist and pose a significant burden for patients. The OverSEA project aims to provide recommendations for managing these patients. Method: A two-round Delphi survey involving 205 experts from 8 European countries [156 pulmonologists (PNs), 28 allergists (As) and 21 ear, nose, and throat specialists (ENTs)] resulted in consensus recommendations (≥70%) for treating patients with SEA and CRSwNP. Results: Recommendations cover treatment objectives and evaluation criteria, steps for managing worsening of CRSwNP and multidisciplinary management (Fig. 1). PROs like the ACT were favored for SEA, but no consensus among ENTs emerged for CRSwNP-specific PROs, though SNOT-22 scored highest. PNs/As advocated for biologics as a first-line treatment option for severe, uncontrolled comorbid patients, and viewed nasal polyp surgery as a last resort when other interventions have proven ineffective. In contrast, ENTs did not share the same perspective (Fig. 1). However, all specialties agreed that the selected biologic should reduce exacerbations and target the underlying CRSwNP pathogenesis and type 2 inflammation. Conclusion: The OverSEA recommendations are the largest European initiative providing insights for optimizing the management of patients with SEA and comorbid CRSwNP. erj;64/suppl_68/PA3991/F1F1F1