Uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis; it is typically characterized by a type 2 inflammatory reaction and by comorbidities, including asthma, nonsteroidal anti-inflammatory drug–exacerbated respiratory disease, and allergies. Here, the European Forum for Research and Education in Allergy and Airway Diseases proposes structured definitions to enable communication between clinicians and provides a practical algorithm to define type 2 inflammation in CRSwNP in daily clinical practice. A rational approach for the treatment of uncontrolled severe CRSwNP is discussed; it consists of evaluating the perspective and risks of surgery and efficacy and adverse events of biologics on the basis of currently available data. Further, possible combinations of surgery and biologics are discussed, and a rationale is provided. Here, it is of importance to adequately counsel the patient about both approaches to enable a decision-making process with an informed patient. Criteria for the selection of a biologic drug are provided, as several biologics for uncontrolled severe CRSwNP will be available in many countries within a short time. Further, suggestions for monitoring of the drug effects that support recognition of responders to the therapy and, subsequently, the decision regarding continuation or discontinuation of the biologic are proposed.

患有鼻息肉（CRSwNP）的不受控制的严重慢性鼻-鼻窦炎是慢性鼻-鼻窦炎最令人讨厌的表型。它的典型特征是2型炎症反应和合并症，包括哮喘，非甾体类抗炎药加剧的呼吸道疾病和过敏。在这里，欧洲变态反应和呼吸道疾病研究与教育论坛提出了结构化的定义，以使临床医生之间能够进行交流，并提供了一种实用的算法来定义日常临床实践中CRSwNP中的2型炎症。讨论了治疗不受控制的严重CRSwNP的合理方法。它包括根据现有数据评估手术的观点和风险以及生物制剂的功效和不良事件。进一步，讨论了外科手术和生物制剂的可能组合，并提供了基本原理。在此，重要的是要充分建议患者有关这两种方法的信息，以使知情的患者能够做出决策。提供了选择生物药物的标准，因为许多国家将在短时间内提供一些不受控制的严重CRSwNP的生物制剂。此外，提出了用于监测药物作用的建议，这些药物支持对治疗的反应者的识别，并随后决定有关生物制剂继续或终止的决定。提供了选择生物药物的标准，因为许多国家将在短时间内提供一些不受控制的严重CRSwNP的生物制剂。此外，提出了用于监测药物作用的建议，这些药物支持对治疗的反应者的识别，并随后决定有关生物制剂继续或终止的决定。提供了选择生物药物的标准，因为许多国家将在短时间内提供一些不受控制的严重CRSwNP的生物制剂。此外，提出了用于监测药物作用的建议，这些药物支持对治疗的反应者的识别，并随后决定有关生物制剂继续或终止的决定。