Cath Ross, a 59-year-old civil servant from Lowestoft, has regained her sense of taste and smell using a newly approved NHS drug called dupilumab.
The National Institute for Health and Care Excellence approved the treatment in February for patients with severe chronic rhinosinusitis with nasal polyps, known as CRSwNP.
Ross suffered from severe sinus blockages for 20 years, struggling to breathe and suffering from constant sleep deprivation. She lives in Lowestoft, Suffolk, with her husband Peter, 63, a chief finance officer, and has two adult sons.
Her blocked nasal passage forced her to sleep with her mouth open, causing heavy snoring that disturbed her husband. If her mouth closed, she would wake up with a start because she could not breathe.
Air could only escape through a tiny gap in her blocked sinuses, creating a whistling sound during work meetings. Ross said it felt humiliating and sounded like someone trying to whistle poorly through their mouth.
The condition also completely robbed her of her sense of taste and smell.
"I couldn't taste even strong flavours such as garlic or a spicy curry," Ross said. "It took away the pleasure of eating and made my life a misery."
She avoided eating in public because breathing required her to eat with her mouth open. She added that at that point her symptoms were getting worse and going out to eat seemed pretty pointless.
Decade of failed conventional treatments
Steroid sprays prescribed by her doctor provided no relief, and sinus surgery performed in 2007 brought only temporary help before symptoms returned within 12 months.
She participated in a clinical trial for dupilumab in 2017 but believed she received a placebo. After undergoing a second trial and further unsuccessful surgery, drug manufacturer Sanofi granted her compassionate access to dupilumab in 2022 because all other therapies had failed.
Sanofi funded the treatment, which costs around £1,200 per month compared to £3,000 for sinus surgery. Within two weeks of starting the drug, her smell and taste returned while she was filling her car, when the scent of petrol felt very powerful.
Ross administers the medication once every fortnight using an injector pen. She noted that while she feels slightly bunged up on the morning an injection is due, the congestion disappears within 24 hours of taking the dose, and Sanofi continues to fund her treatment.
Understanding chronic rhinosinusitis and polyps
CRSwNP is a common long-term inflammatory disease that causes persistent swelling in the lining of the sinuses, nasal passage, and nasal cavity. Sinuses are the air-filled cavities around the nose behind the cheekbones and forehead.
According to the charity SmellTaste, which operates at smelltaste.org.uk, chronic rhinosinusitis affects around 11 per cent of the population, representing roughly 5.5 million people. More than 25 per cent of those affected have CRSwNP.
Doctors state the condition is one of the main reasons people lose their sense of smell, but it remains underdiagnosed because many people mistake its symptoms for allergies or colds. Because symptoms progress slowly, patients often do not notice the impact initially.
About 30 per cent of people with chronic rhinosinusitis develop soft, painless, non-cancerous growths called nasal polyps, which form in the sinuses before stretching into the nasal cavity. Diagnosis is made using an endoscopy, where a camera on a thin tube examines the nasal area.
A 2022 Dutch study published in Respiratory Medicine revealed that nearly half of patients experience recurring symptoms within a year of undergoing surgery, often because underlying inflammation remains uncontrolled.
Expert medical analysis on treatments
Matthew Trotter, a consultant ear, nose and throat surgeon at University Hospitals Coventry and Warwickshire NHS Trust and Spire Parkway Hospital in Solihull, said having the condition is effectively like having a bad cold without feeling unwell, making it very debilitating.
Trotter explained that it remains unclear what causes the disease or why some patients develop polyps while others do not. Polyps can grow to the size of a large grape, causing pain in the face and forehead across four pairs of sinuses, alongside nasal congestion, a runny nose, nasal secretions dripping down the throat, and occasionally eye itching.
First-line treatment involves steroid nasal sprays or short courses of high-dose steroid tablets to reach deep cavities. If steroids fail, surgeons remove polyps under general anaesthetic after evaluating quality of life through the Sino Nasal Outcome Test questionnaire, known as SNOT 22.
Trotter noted that surgery aims to improve breathing rather than remove every polyp, as delicate sinus linings could be damaged. He emphasized that dupilumab provides a superb option for patients with recurring polyps, giving doctors a way to modify the disease and prevent repeated operations.
Biological mechanism and future therapies
Carl Philpott, professor of rhinology and olfactology at the University of East Anglia, who runs a smell and taste clinic at James Paget University Hospital in Great Yarmouth, Norfolk, explained that dupilumab belongs to a class of drugs known as monoclonal antibodies.
The drug works by blocking cytokines, which are proteins released by cells that trigger inflammation. Specifically, dupilumab blocks interleukin 4 and interleukin 13 from recruiting inflammatory cells that cause swelling and polyp formation.
While traditional steroid treatments can cause severe side-effects such as high blood pressure and diabetes, monoclonal antibodies do not. Dupilumab, which is also used to treat some asthma and eczema patients, may cause mild side-effects including muscle ache or dry, itching eyes.
To qualify for dupilumab on the NHS following NICE approval, patients must have suffered from the condition for at least 12 weeks, failed to respond to steroids, and either undergone at least one surgery or demonstrated severe life impact.
Philpott noted that alternative therapies such as tezepelumab are currently licensed for CRSwNP but not yet approved by NICE, adding that as more options arrive over the next decade, reduced costs will make them more readily available on the NHS. For Ross, the treatment has allowed her to enjoy holidays, socialise, and appreciate the scents of candles, flowers, perfumes, aftershave, and freshly cut grass.
