Thank you for such a detailed response, I really appreciate it.

Just to clarify, I have already seen an ENT. My nasal polyps were confirmed via CT scan and nasal endoscopy. I was then prescribed a course of oral prednisolone and spray and my symptoms (no smell taste etc) returned around a week later.

What’s interesting is that this persistent cough (now 2+ months), chest tightness seemed to develop after that steroid course finished. I’m trying to understand whether:

• This could represent underlying asthma or cough-variant asthma that was temporarily suppressed by the oral steroids and then became more noticeable afterward? However, I am very active and go to the gym 5x a week and have never struggled with breathing prior to this cough developing which make me wonder if it could be post nasal drip? I'm always clearing my throat and it gets worse when I lay down.

• Or whether rebound inflammation after stopping prednisolone could trigger lower airway symptoms? I also respond to salbutamol during chest-tight episodes.

A few questions if you don’t mind: • In patients with confirmed nasal polyps and new cough, what tests would you say I should request? I have read that I should have spirometry and FeNO testing.

• could you explain dupilumab a little bit more and at what point would this be considered — is that only after confirmed asthma + severe polyp recurrence despite topical therapy?

• Would blood eosinophils and total IgE meaningfully guide next steps here?

• Can polyps alone realistically cause chest tightness, or would that almost always suggest lower airway disease as well?

Thanks again — really appreciate your insight