Abstract
BackgroundNonsteroidal anti‐inflammatory drug (NSAID) exacerbated respiratory disease (N‐ERD) is a triad with asthma, chronic rhinosinusitis with nasal polyps, and NSAID intolerance. Uncontrolled N‐ERD forms a major public health problem due to frequent and difficult‐to‐treat exacerbations and/or requiring putatively frequent endoscopic sinus surgeries (ESS). Our aim was to study factors affecting control of N‐ERD.MethodsRetrospective patient record data (patient characteristics, prior sinus surgeries, follow‐up data in 2020) from 167 N‐ERD patients undergoing consultation at three tertiary hospitals from 2001 to 2017 was used. Outcome measurements reflecting uncontrolled N‐ERD were revision ESS, corticosteroids/biological therapy, and antibiotic courses during 2016–2020. Associations were analyzed by using nonparametric tests, Cox's proportional hazard, and binary logistic regression models.ResultsNasal polyp eosinophilia increased the risk of revision surgery during the follow‐up (adjusted hazard ratio [aHR] 3.21, confidence interval 1.23–8.38). Also baseline oral corticosteroids (OCS; HR, 1.73, 1.04–2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07–4.42) in unadjusted models. In addition, both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23–6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98–4.70) were associated with the use of OCS/biological therapy during the follow‐up, but not with high number of antibiotics.ConclusionsNasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N‐ERD. These factors might be clinically useful in risk‐estimation of uncontrolled disease and for organizing follow‐ups. Prospective cohort studies with larger sample size are needed to further study the factors affecting the upper airway control of N‐ERD.
Highlights
Chronic rhinosinusitis (CRS) is defined as chronic inflammation (≥12 weeks) of the nose and paranasal sinuses characterized by rhinitis symptoms and it is diagnosed with nasal endoscopy and computed tomography (CT).[9,10,11,12,13]
The proportion of the Nonsteroidal anti‐inflammatory drug (NSAID)‐exacerbated respiratory disease (N‐ERD) patients who underwent baseline endoscopic sinus surgeries (ESS) was 138 of 167 (82.6%). This patient group data were analyzed in univariate and multivariable Cox's proportional hazard models to analyze the background variables fitted for the need for revision ESS during the follow‐up
Baseline oral corticosteroids (OCS) (HR, 1.73; 1.04–2.89), and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17; 1.07–4.42), in the univariate model (Table 2)
Summary
Nonsteroidal anti‐inflammatory drug (NSAID) exacerbated respiratory disease (N‐ERD) is an inflammatory disease of the airways usually including a triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and hypersensitivity to acetylsalicylic acid (ASA) and other NSAIDs.[1,2] Patients with N‐ERD have severe eosinophilic hyperplastic inflammation, tissue remodeling, and fibrosis of both the paranasal sinuses and lower airways, and abnormalities of the cyclo‐oxygenase (COX) pathway.[1,3,4] N‐ERD is slightly more common in females, it typically starts around the age of 30, and has an estimated prevalence of 9% in patients with asthma.[5,6]Chronic rhinosinusitis (CRS) is one of the most common chronic adult health problems and causes severe impact on the quality of life.[7,8,9] CRS is defined as chronic inflammation (≥12 weeks) of the nose and paranasal sinuses characterized by rhinitis symptoms and it is diagnosed with nasal endoscopy and computed tomography (CT).[9,10,11,12,13] CRS phenotypes include CRSwNP and CRS without nasal polyps (CRSsNP). Baseline oral corticosteroids (OCS; HR, 1.73, 1.04–2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07–4.42) in unadjusted models. Both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23–6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98–4.70) were associated with the use of OCS/biological therapy during the follow‐up, but not with high number of antibiotics. Conclusions: Nasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N‐ERD.
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