Table II.

Comparison of EPOS guidelines to real-life practice regarding practical management of CRS.

	EPOS2020 guidelines	Italian real-life practice (% of responders)
Practical management of asthma patients with CRSwNP	A patient’s self-assessment of their chest symptoms (wheeze, shortness of breath, chest tightness, and cough) and severity is often poor, or they may even be unaware that the lower respiratory tract is affected so objective assessment of lower airways is necessary	In the presence of a patient with moderately/severe CRSwNP who has never been operated on and has never taken biological therapy, 76% of respondents believe that evaluation of lower airways with objective testing is required
Practical management of severe CRSwNP patients naïve to surgical treatment	The EPOS2020 steering group was unclear as to whether nasal cytology, nasal lavage, blood eosinophilia and IgE in CRS patient at presentation of symptoms or after failure of previous treatment	In practice respondents consider in naïve patients with moderately/severe CRSwNP blood eosinophil count (86.44%), total IgE (79.66%), local nasal eosinophilia (52.54%)
	EPOS steering group suggested that QoL instruments are important for the management of CRS (100%) and the SNOT-22 was the most used 84%	In practice 98.31% of respondents believe that QOL Questionnaires are important and use SNOT-22
	Nasal endoscopy is an essential part of the rhinological examination	In practice, 100% of respondents believe that nasal endoscopy is important and use it
	EPOS criteria consider this scenario and put the endoscopic sinus surgery (ESS) procedure as a given in order to access biological therapy. However, EPOS also considers exceptional circumstances in which treatment can be accessed without prior ESS (e.g., not fit for surgery)	In real-life practice, the respondents usually take into consideration not only the contraindications to surgery but also factors predictive of failure and even categorical refusal of the patient
Practical management of CRSwNP patients initiating and during biologic therapy	Recommendations regarding the response criteria for biologicals in the treatment of CRS can be found that include reduced nasal polyp size, reduced need for systemic corticosteroids, improved quality of life, improved sense of smell and reduced impact of comorbidities	What parameters do you use to establish the response of biological therapy at 12 months? NPS (93%) SNOT-22(100%), NCS (32%), PNIF (18.64%)
		Improved comorbidities (ACT 28.81% – spirometry -16.95%) improved sense of smell, olfactometry 55.93%
	No practical management/timing guidelines are given	What is your timing of follow up for a patient with CRSwNP on biologic therapy in the first year of treatment?
		15 days, 1 month, 3 months, 6 months, 9 months, 1 year (64.41%)
		Every month (5.08%)
		Every 3 months (25.42%); every 6 months (5.08%)
Practical management of patients with secondary CRSwNP associated to EGPA	EGPA should be considered in any patient with severe nasal polyposis, not responding to conventional therapy, crusting/bleeding and severe symptoms, marked peripheral eosinophilia (usually > 1500/cells/ul or > 10%) and ANCA-positivity (not always present). However, Delphi consensus is unclear on if it essential to do an objective test for vasculitis in CRS after failure of previous treatment	In practice, respondents consider it necessary to screen for autoimmunity patient with severe and uncontrolled CRSwNP in the case of very high values of blood hypereosinophilia (49.15%) without agreement on a specific cut-off, in case of other associated autoimmune diseases (64.41%). In case of obvious alterations of the nasal mucosa (e.g., septal perforations, crustiness) (35.59%)
Practical management of NSAID exacerbated respiratory disease	All patients with CRS should be asked about reactions to aspirin and NSAIDs. At least one documented reaction to aspirin or NSAIDs is required to make the diagnosis of NSAID-ERD though history alone is not always reliable. Aspirin provocation tests are needed when the history is not clear	The diagnosis of NSAID-ERD is mainly based on clinical history including asthma, nasal polyps, and respiratory reactions to NSAIDs (85%)