Multidisciplinary approach for phenotyping and endotyping upper and lower airway diseases.

The aim of this study was to better characterize different phenotypes and endotypes of upper and lower airway diseases by means of a multidisciplinary approach including allergy, ENT, and pulmonology evaluations. Patients and methods: a total of 87 patients with upper and/or lower airway diseases and 15 healthy controls have been recruited from July 2019 to September 2022. All the patients underwent multidisciplinary evaluation, including allergy, ENT, and pulmonology evaluations. Among this cohort, 10 patients with asthma underwent induced sputum collection in order to analyze the rate of spontaneous NETosis in lower airway. In parallel, 77 patients with CR [36 with allergic rhinitis (AR), 13 with non-allergic rhinitis (NAR), and 28 with suspected local allergic rhinitis (LAR)] underwent nasal fluid collection in order to quantify total IgE, specific IgE (sIgE) to grass pollen and house dust mites (HDM), ECP, IL-4, IL-5, IFN-γ, and IL-10. Results: by analyzing the induced sputum of asthmatic patients we found that the rate of spontaneous NETosis in neutrophils significantly correlated with the number of neutrophils in the same sample. Furthermore, the rate of spontaneous NETosis was significantly higher in neutrophilic versus eosinophilic asthma. Nasal fluid analysis in CR patients revealed that the mean levels of nasal sIgE to both grass pollen and HDM were6 higher in AR group, in line with the results of conventional allergy diagnostic tools. Nasal sIgE to grass pollen and/or HDM were detected in 18% of all suspected LAR with a sensitization to grass pollen confirmed in 17% of patients with seasonal symptoms and to HDM in 9% with perennial symptoms. Cytokines levels were not significantly different in either CR groups versus healthy controls, or between the three CR groups. Conclusion: a multidisciplinary evaluation may be essential to identify novel biomarkers for phenotyping and endotyping patients with upper and lower airway diseases and provide a precision-medicine approach in these patients