Aspirin exacerbated respiratory disease in a tertiary care population

Published online: April 12, 2016

Chronic Rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and sinuses. As many as 31 million Americans have CRS and approximately $22 billion is spent annually on medical costs. Some CRS patients also develop nasal polyps, which are benign outgrowths in the nasal cavity. As many as 48% of patients with CRSwNP are estimated to have asthma. There is another subgroup of patients who have both CRSwNP and asthma and cannot take non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen due to reactions induced by these drugs. These patients with asthma, CRSwNP, and an NSAID intolerance are clinically diagnosed with Aspirin Exacerbated Respiratory Disease (AERD). The prevalence of AERD among patients with CRSwNP is unclear and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone or those with both CRSwNP and Asthma (CRSwNP+Asthma).  

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Stevens and colleagues determined the prevalence of AERD within a tertiary care setting and identified unique clinical features that could distinguish these patients from those with both CRSwNP and Asthma or those with CRSwNP alone. To do so, electronic medical records of patients at Northwestern University were searched using a computer algorithm to identify patients with CRS. Then, the medical charts were personally reviewed by a physician, and 459 patients with CRSwNP alone, 412 with both CRSwNP+Asthma, and 171 with AERD were identified.

In this study, 16% of patients with CRSwNP had AERD. AERD patients were more likely to be female than patients with CRSwNP alone. Additionally, AERD patients had undergone two-times as many sinus surgeries and were significantly younger at the time of their first surgery (40±13 years) than other CRSwNP patients (43±14 years). Atopy was significantly more prevalent in patients with AERD (84%) than in CRSwNP alone (66%). Significantly more patients with AERD (13%) needed daily oral steroids to control their disease than patients with CRSwNP+Asthma (4%).
 
AERD is common among CRSwNP patients in a tertiary care setting and is a disease physicians will likely encounter in their clinical practice. While AERD patients have CRSwNP and asthma, the clinical course of their disease is not the same as that of patients who have CRSwNP and asthma but are able to tolerate NSAIDs. AERD is typically more severe than either CRSwNP alone or CRSwNP with comorbid asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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