Exploration of Asthma & Allergy

Table 2. Sino-Nasal Outcome Test-22 (SNOT-22).

Symptom	No problem	Very mild problem	Mild or slight problem	Moderate problem	Severe problem	Problem as bad as it can be
1. Need to blow the nose	0	1	2	3	4	5
2. Sneezing	0	1	2	3	4	5
3. Runny nose	0	1	2	3	4	5
4. Cough	0	1	2	3	4	5
5. Post-nasal discharge (dripping at the back of your nose)	0	1	2	3	4	5
6. Thick nasal discharge	0	1	2	3	4	5
7. Ear fullness	0	1	2	3	4	5
8. Dizziness	0	1	2	3	4	5
9. Ear pain/pressure	0	1	2	3	4	5
10. Facial pain/pressure	0	1	2	3	4	5
11. Difficulty falling asleep	0	1	2	3	4	5
12. Waking up at night	0	1	2	3	4	5
13. Lack of a good night’s sleep	0	1	2	3	4	5
14. Waking up tired	0	1	2	3	4	5
15. Fatigue during the day	0	1	2	3	4	5
16. Reduced productivity	0	1	2	3	4	5
17. Reduced concentration	0	1	2	3	4	5
18. Frustrated/restless/irritable	0	1	2	3	4	5
19. Sad	0	1	2	3	4	5
20. Embarrassed	0	1	2	3	4	5
21. Sense of taste/smell	0	1	2	3	4	5
22. Blockage/congestion of the nose	0	1	2	3	4	5
Total SNOT-22 score

Return to article view

Higher scores on the SNOT-22 survey items suggest worse patient functioning or symptom severity (total score range: 0–110). Adapted with permission from [31]. © Copyright-2013 American College of Allergy, Asthma & Immunology.

Declarations

Author contributions

EA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing—original draft, Writing—review & editing. MD: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. AB: Supervision. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was conducted in accordance with the principles outlined in the Declaration of Helsinki, and the study protocol was approved by the Institutional Review Board of KTO Karatay University Hospital (IRB No. 2023/031).

Consent to participate

Informed consent to participate in the study was obtained from all participants.

Consent to publication

Not applicable.

Availability of data and materials

The data of this manuscript could be available from the corresponding author upon reasonable request.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

2024 GINA Main Report [Internet]. Global Initiative for Asthma – GINA; c2026 [cited 2024 May 22]. Available from: https://ginasthma.org/2024-report/

Castagnoli R, Licari A, Brambilla I, Tosca M, Ciprandi G, Marseglia GL. An update on the role of chronic rhinosinusitis with nasal polyps as a co-morbidity in severe asthma. Expert Rev Respir Med. 2020;14:1197–205. [DOI] [PubMed]

Seccia V, D’Amato M, Scioscia G, Bagnasco D, Marco FD, Fadda G, et al. Management of Patients with Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps: A Multidisciplinary Shared Approach. J Pers Med. 2022;12:1096. [DOI] [PubMed] [PMC]

Israel E, Canonica GW, Brusselle G, Yang S, Howarth PH, Martin AL, et al. Real-life effectiveness of mepolizumab in severe asthma: a systematic literature review. J Asthma. 2022;59:2201–17. [DOI] [PubMed]

Pavord ID, Bel EH, Bourdin A, Chan R, Han JK, Keene ON, et al. From DREAM to REALITI-A and beyond: Mepolizumab for the treatment of eosinophil-driven diseases. Allergy. 2022;77:778–97. [DOI] [PubMed] [PMC]

Agache I, Rocha C, Beltran J, Song Y, Posso M, Solà I, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma: A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy. 2020;75:1043–57. [DOI] [PubMed]

Scioscia G, Nolasco S, Campisi R, Quarato CMI, Caruso C, Pelaia C, et al. Switching Biological Therapies in Severe Asthma. Int J Mol Sci. 2023;24:9563. [DOI] [PubMed] [PMC]

Nagase H, Suzukawa M, Oishi K, Matsunaga K. Biologics for severe asthma: The real-world evidence, effectiveness of switching, and prediction factors for the efficacy. Allergol Int. 2023;72:11–23. [DOI] [PubMed]

Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58:1–464. [DOI] [PubMed]

10.

Liu MC, Bagnasco D, Matucci A, Pilette C, Price RG, Maxwell AC, et al. Mepolizumab in Patients With Severe Asthma and Comorbidities: 1-Year REALITI-A Analysis. J Allergy Clin Immunol Pract. 2023;11:3650–61.e3. [DOI] [PubMed]

11.

Domínguez-Sosa MS, Cabrera-Ramírez MS, Marrero-Ramos MDC, Dávila-Quintana D, Cabrera-López C, Carrillo-Díaz T, et al. Real-Life Effectiveness of Mepolizumab in Refractory Chronic Rhinosinusitis with Nasal Polyps. Biomedicines. 2023;11:485. [DOI] [PubMed] [PMC]

12.

Han JK, Bachert C, Fokkens W, Desrosiers M, Wagenmann M, Lee SE, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med. 2021;9:1141–53. [DOI] [PubMed]

13.

Perez-de-Llano L, Scelo G, Tran TN, Le TT, Fagerås M, Cosio BG, et al. Exploring Definitions and Predictors of Severe Asthma Clinical Remission after Biologic Treatment in Adults. Am J Respir Crit Care Med. 2024;210:869–80. [DOI] [PubMed] [PMC]

14.

Lommatzsch M. Remission in asthma. Curr Opin Pulm Med. 2024;30:325–9. [DOI] [PubMed] [PMC]

15.

Shackleford A, Heaney LG, Redmond C, McDowell PJ, Busby J. Clinical remission attainment, definitions, and correlates among patients with severe asthma treated with biologics: a systematic review and meta-analysis. Lancet Respir Med. 2025;13:23–34. [DOI] [PubMed]

16.

Pavord I, Gardiner F, Heaney LG, Domingo C, Price RG, Pullan A, et al. Remission outcomes in severe eosinophilic asthma with mepolizumab therapy: Analysis of the REDES study. Front Immunol. 2023;14:1150162. [DOI] [PubMed] [PMC]

17.

Uysal MA, Mungan D, Yorgancioglu A, Yildiz F, Akgun M, Gemicioglu B, et al.; Turkish Asthma Control Test (TACT) Study Group. The validation of the Turkish version of Asthma Control Test. Qual Life Res. 2013;22:1773–9. [DOI] [PubMed]

18.

Atayık E, Aytekin G. A Single Center Experience of Super-Responders Among Severe Asthma Patients Receiving Treatment with Mepolizumab. Turk Thorac J. 2022;23:348–54. [DOI] [PubMed] [PMC]

19.

Bagnasco D, Caminati M, Menzella F, Milanese M, Rolla G, Lombardi C, et al. One year of mepolizumab. Efficacy and safety in real-life in Italy. Pulm Pharmacol Ther. 2019;58:101836. [DOI] [PubMed]

20.

Pelaia C, Crimi C, Pelaia G, Nolasco S, Campisi R, Heffler E, et al. Real-life evaluation of mepolizumab efficacy in patients with severe eosinophilic asthma, according to atopic trait and allergic phenotype. Clin Exp Allergy. 2020;50:780–8. [DOI] [PubMed]

21.

Kavanagh JE, d’Ancona G, Elstad M, Green L, Fernandes M, Thomson L, et al. Real-World Effectiveness and the Characteristics of a “Super-Responder” to Mepolizumab in Severe Eosinophilic Asthma. Chest. 2020;158:491–500. [DOI] [PubMed]

22.

van Toor JJ, van der Mark SC, Kappen JH, In ’t Veenn JCCM, Braunstahl GJ. Mepolizumab add-on therapy in a real world cohort of patients with severe eosinophilic asthma: response rate, effectiveness, and safety. J Asthma. 2021;58:651–8. [DOI] [PubMed]

23.

Harvey ES, Langton D, Katelaris C, Stevens S, Farah CS, Gillman A, et al. Mepolizumab effectiveness and identification of super-responders in severe asthma. Eur Respir J. 2020;55:1902420. [DOI] [PubMed]

24.

Langton D, Sha J, Guo S, Sharp J, Banks C, Wang W, et al. Bronchial thermoplasty versus mepolizumab: Comparison of outcomes in a severe asthma clinic. Respirology. 2020;25:1243–9. [DOI] [PubMed]

25.

Hussain M, Liu G. Eosinophilic Asthma: Pathophysiology and Therapeutic Horizons. Cells. 2024;13:384. [DOI] [PubMed] [PMC]

26.

Fokkens WJ, Mullol J, Kennedy D, Philpott C, Seccia V, Kern RC, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy. 2023;78:812–21. [DOI] [PubMed]

27.

Cameli P, Bergantini L, d’Alessandro M, Perruzza M, Cekorja B, Perillo F, et al. A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting. Int Arch Allergy Immunol. 2020;181:606–12. [DOI] [PubMed]

28.

Bachert C, Sousa AR, Han JK, Schlosser RJ, Sowerby LJ, Hopkins C, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps: Treatment efficacy by comorbidity and blood eosinophil count. J Allergy Clin Immunol. 2022;149:1711–21.e6. [DOI] [PubMed]

29.

Crimi C, Nolasco S, Noto A, Maglio A, Quaranta VN, Bona DD, et al. Long-Term Clinical and Sustained REMIssion in Severe Eosinophilic Asthma Treated With Mepolizumab: The REMI-M Study. J Allergy Clin Immunol Pract. 2024;12:3315–27. [DOI] [PubMed]

30.

Kallieri M, Papaioannou AI, Loukides S. Mepolizumab for severe eosinophilic asthma. Expert Rev Respir Med. 2026;20:13–25. [DOI] [PubMed]

31.

Kennedy JL, Hubbard MA, Huyett P, Patrie JT, Borish L, Payne SC. Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis. Ann Allergy Asthma Immunol. 2013;111:246–51. [DOI] [PubMed] [PMC]

32.

Ferguson BJ, Rizk H, Ramakrishnan J, Pant H. Categorization of Nasal Polyps. In: Önerci T, Ferguson B, editors. Nasal Polyposis. Berlin: Springer; 2010. pp. 103–10. [DOI]

33.

Detoraki A, Tremante E, D’Amato M, Calabrese C, Casella C, Maniscalco M, et al. Mepolizumab improves sino-nasal symptoms and asthma control in severe eosinophilic asthma patients with chronic rhinosinusitis and nasal polyps: a 12-month real-life study. Ther Adv Respir Dis. 2021;15:17534666211009398. [DOI] [PubMed] [PMC]