How long does it take for chronic rhinitis with nasal polyps to develop into eosinophilic asthma?

Hi doctor,

I wanted to ask about asthma, my risk of developing it, and if there is anything I can do to prevent it. I have a history of chronic rhinitis with nasal polyps, which I have had for the past 13 years. It is managed with intranasal steroids and antihistamines. My blood eosinophil count was 500.00 /µL; on a routine blood test, the doctor said it was probably on the high side due to the rhinitis. I have still not established a cause for the rhinitis. All allergy skin blood tests have been negative, and I cannot identify a specific trigger, even though antihistamines help. I have perhaps noticed a worsening of symptoms when it rains. I consulted with an ENT doctor (as my nasal symptoms are becoming harder to control), who confirmed small polyps via endoscopy but based on the sinus computed tomography (CT) scan, he decided that I did not need surgery. I worry about developing asthma (particularly eosinophilic asthma, the severe type as I have read that most people with rhinitis, particularly polyps with high eosinophil count, develop asthma too, which tends to be severe. I enjoy running and extensive exercise and know that severe asthma can greatly impact the ability to exercise. I also have a family history and my father has had adult-onset asthma (mild-moderate severity) with polyps though his rhinitis is not as chronic as mine. I attended my doctor several months ago as I was feeling short of breath following a covid infection. A chest X-ray was normal. However, my peak flow was low (300 as it always has been), and I trialed a steroid inhaler for a month which did not improve peak flow or symptoms. Therefore my doctor did not do further tests for asthma and instead referred me to the long COVID-19 clinic. Given the above risk factors, I was wondering how likely this is to progress to asthma and if I can do anything to prevent it. I am trying to manage my rhinitis the best I can but worry about it progressing to asthma due to my nose's severity or level of inflammation. I have not had any chest symptoms yet, but I am scared that as I am at high risk for developing asthma, it will suddenly start any day. I have read that asthma attacks can come on very suddenly and be fatal. As I live in a cold environment, I thought about moving to a drier climate, but would this be a bit excessive if it will not make that much difference?

Hi doctor,

Thanks for your reply. I have attached the latest allergy test report; I apologize for not uploading the whole document. The test was thorough and did not identify any allergens. Unfortunately, I have also been unable to identify a trigger through experience, making me wonder if my condition is nonallergic rhinitis. I am still determining what other tests I can have to confirm if this is allergic or nonallergic. If antihistamine tablets help (which they do a little), does this indicate that it is more likely to be allergic than nonallergic rhinitis? What made me worry about the risk is that I also have nasal polyps (confirmed by an ear, nose, throat (ENT) consultant via nasal endoscopy) and a family history of asthma (my father developed adult-onset asthma and polyps when he was in his 40s). In addition, I have had a high blood eosinophil count of 500.00 /µL and was therefore worrying about the later development of eosinophilic asthma, which I have read is associated with polyps. Do you think the risk of asthma development is still low even if my rhinitis is nonallergic?

Hi doctor,

I have not had a pulmonary function test (PFT), as I was concerned (even though I had no asthma symptoms), and due to my being at higher risk, my doctor did a peak flow test (I scored 300). For my height, he said I should be scoring around 420. He trialed me on a Beclometasone steroid inhaler for one month; however, it did not improve my peak flow or make any difference. I still scored 300 after the trial. He, therefore, did not complete any further pulmonary testing. It might be worth me mentioning that I had always scored low on peak flow. Even when I did it in college, I could only reach 300. I suppose I am wondering about the risk of progression to asthma. Given my situation, is there a higher risk for non-allergic rhinitis? I have read in a study that most people with nonallergic/rhinitis and polyps develop asthma. Is this correct? If there is anything I can do to prevent it from progressing to asthma in the future.

Hi doctor,

Thank you for the reply. I will ask my doctor for a pulmonary function test (PFT). I do not get the main asthma symptoms, such as chest tightness, breathlessness, or wheezing. I do not get a suffocating feeling, but I do get anxiety and sometimes feel like I am not getting enough oxygen - when my anxiety improves, this symptom improves also. I still have a little anxiety in general, but it is better. My nasal issues contribute to anxiety, too, as sometimes my nose and back of my upper throat feel very stuffy (I feel a bit of tightness in my neck), and it is during these times I panic a bit about my lower airways in case the inflammation spreads.

Hello doctor,

Thanks for your reply. Yes, I have anxiety but this is being treated with cognitive behavioral therapy (CBT). I do not have typical symptoms of acid reflux however for the past two years I have isolated hiccups throughout the day. I will say four single hiccups at a time. There appears to be no trigger. I do not experience chest burning or pain. I think part of my anxiety is a fear of suddenly developing asthma, due to my non-allergic rhinitis and polyps as my dad had polyps and asthma. I am told I am at high risk. I have been referred for lung function tests (spirometry and reversed salbutamol test). I am still waiting for this. I am wondering at what risk am I for developing eosinophilic asthma as my blood eosinophil count is already high (0.5) and I have read that it is associated with nasal polyps. Kindly suggest.

Hello doctor,

I am not sure yet when I can get a pulmonary function test. I am waiting for an appointment letter. I have attached the IgE report earlier in my reply. IgE was negative or the tests showed no allergies.