Recently, Alobid et al.1 published, in collaboration with Spanish respiratory medicine, allergy and otorhinolaryngology academies (SEPAR, SEIAC and SEORL), a nice multidisciplinary consensus on chronic rhinosinusitis with nasal polyps (CRSwNP) and united airway diseases. The EPOS2020 document2 (European position paper on chronic rhinosinusitis and nasal polyps) gather a great effort of upper and lower experts to build the concept of multidisciplinary team (MDT) of united respiratory airway. Caminati et al.,3 using a MDT, stated that the remission in CRSwNP should include (period of ≥12 months): absence of sinonasal symptoms; no impact on quality of life; no need of surgery; no chronic or rescue medications (systemic corticosteroids or antibiotics); and recovery of smell function.

We read with great interest the article by Drs. Álvarez-Gutiérrez et al. entitled “Spanish Consensus on Remission in Asthma (REMAS).”4 The authors involved more than 120 specialists in asthma management to arrive at a consensus on the definitions of remission in asthma and establishing the criteria and characteristics that will be of use in future studies evaluating the efficacy or effectiveness of treatments. We congratulate the interesting study demonstrating that the concept of remission should include the absence of symptoms, no need for systemic glucocorticoids, absence of exacerbations and sustained normal lung function. The authors added a very nice description of the concept of united airway remission, the question arose regarding specific data on the clinical course of CRSwNP (Table 3). Consensus was reached on the recovery of smell, a sinonasal outcome test 22 (SNOT-22) score<30, normal nasal polyp endoscopy score, and no need for systemic glucocorticoids.

The utility of MDT discussions for diagnosis, monitoring and management, will need to be considered based on how it is best positioned in the diagnostic and therapeutic process. Back to paper of Álvarez-Gutiérrez et al. we noticed the no otorhinolaryngologist has participated in the development of the consensus or in the Delphi rounds. Moreover, there is a lack of reliable criteria to evaluate the sinonasal pathway; (1) There is no clear definition on recovery of smell (as a symptom or by smell test); (2) The cut-off value (>30) of SNOT-22 is not supported by the current literature; (3) There is a missing information on the definition of normal nasal endoscopy and lack of experience of participants in this consensus regarding the endoscopic assessment of CRSwNP. EPOS guideline 20202 defined healthy or almost healthy mucosa as a criterion for controlled CRSwNP. However, the real-life studies demonstrated that CRSwNP is a chronic inflammatory disease and nasal mucosa will never be healthy. Recently Arancibia et al.5 defined “clinical recurrence” of CRSwNP of having at least score of 1 on nasal endoscopy and mild nasal obstruction.

As fruit of MDT, all national and international consensuses count on all health professional on respiratory diseases, including allergists, pulmonologist, otorhinolaryngologist and others. However, in the consensus of Álvarez-Gutiérrez et al. none otorhinolaryngologist was included. On the other hand, we feel that the reliability of the consensus is very weak regarding the sinonasal evaluation.