Daily Low-Dose Aspirin Use Leads to a Delay in Diagnosis of Aspirin Exacerbated Respiratory Disease

Abstract

T U E S D A Y 787 Daily Low-Dose Aspirin Use Leads to a Delay in Diagnosis of Aspirin Exacerbated Respiratory Disease Kathleen Lee-Sarwar, Christina Johns, BA, Tanya M. Laidlaw, MD, FAAAAI, Katherine N. Cahill, MD; Brigham and Women’s Hospital, Department of Medicine, Boston, MA, Harvard Medical School, Boston, MA, Brigham and Women’s Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, Brigham and Women’s Hospital, Division of Rheumatology, Immunology, and Allergy, Boston, MA. RATIONALE: Clinical observation suggests use of daily low-dose (81mg) aspirin can obscure the diagnosis of Aspirin Exacerbated Respiratory Disease (AERD). The prevalence and characteristics of patients who tolerate low-dose aspirin without history of a clinical reaction at the time of AERD diagnosis are not known. METHODS: A retrospective chart review of patients with AERD followed at Brigham and Women’s Hospital was performed. Patients taking 81mg of aspirin daily stopped their aspirin at least 10 days before aspirin challenge. History and clinical data of patients on 81mg aspirin daily prior to diagnosis (81mg aspirin group) and of those not on low-dose aspirin (no aspirin group) were compared using non-paired, two-tail T-test and Chi-square analyses. RESULTS: 164 patients were reviewed, with comprehensive data available for 91. Seven (4.3%) took 81mg aspirin daily prior to aspirin challenge; these patients all had refractory nasal polyposis. Average age at diagnostic aspirin challenge was 59.6 years in the 81mg aspirin group, compared with 48.3 years (n566) in the no aspirin group (p 5 0.013). There was no difference in number of lifetime polypectomies. Asthmawas less common among the 81mg aspirin group (5/7 vs. 83/84, p 5 0.015). Four of the 81mg aspirin patients initiated high-dose aspirin therapy; all reported subjective improvement and none required repeat polypectomy (average follow-up 26 months, range 5-37 months). On high-dose aspirin their FEV1 (n53) increased by at least 10%. CONCLUSIONS: Tolerance of low-dose aspirin results in delayedAERD diagnosis, and is associated with lower asthma prevalence and clinical benefit from high-dose aspirin.