Aspirin-exacerbated respiratory disease: association of sinus and asthma morbidity

Published online: April 1, 2021

Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, chronic rhinosinusitis with nasal polyps, and hypersensitivity to aspirin and other non-steroidal anti-inflammatory drugs. Anecdotally, sinus symptom severity seems to be related to asthma symptom severity, but that relationship is not well established in the literature. The association of these symptoms matters because certain treatments such as medical management or surgery may be undertaken if the sinus or asthma symptoms are not well controlled. The aim of this study by Dr. Regan Bergmark et al. in The Journal of Allergy and Clinical Immunology: In Practice was to determine the association between sinonasal and pulmonary symptoms in AERD.

Data from the Brigham and Women’s Hospital AERD registry, which included 1065 patients with AERD, was analyzed for this study. Patient reported sinus and nasal symptoms were measured with the Sino-Nasal Outcomes Test (SNOT) 22-item total score, a validated patient reported outcome measure. Asthma severity was determined in two ways: using the Asthma Control Test (ACT) score, which is a patient reported outcome measure, and by measuring lung function using the percent predicted forced expiratory volume in one second (FEV1%). Statistical analysis was completed to determine if the SNOT-22 scores predicted asthma severity in AERD patients. An additional test was completed to evaluate whether ACT was predictive of the spirometry result. All tests completed on the same day were used in the statistical testing.  The SNOT-22 scores and asthma severity were also described.

The most severe SNOT-22 symptoms in these patients with AERD were problems with sense of smell/taste and blockage/congestion of the nose. More severe SNOT-22 sinus symptoms predicted worse ACT scores and lower FEV1% predicted. Any ten-point worsening in SNOT-22 score was associated with a 0.87-point worsening in ACT score and a 0.75% worsening in FEV1% predicted. ACT scores also predicted FEV1% predicted, meaning that patient reported asthma symptoms were predictive of lung spirometry results. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity in patients with AERD.

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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