Relationship between nasal challenges with acetylsalicylic acid and the severity of non-steroidal anti- inflammatory drugs-exacerbated respiratory disease (N-ERD)

Introduction:

The non-steroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (N-ERD) complicates the clinical course of chronic rhinosinusitis with nasal polyps (CRSwNP). Our aim was to determine the detection rate of N-ERD by means of nasal challenge with acetylsalicylic acid (ASA) and to examine the relationship between the severity of disease regarding rhinological and pulmonary paramters and the degree of nasal ASA challenges.

Methods:

Three groups of patients were included: CRSwNP with asthma and clinical history of analgesics intolerance (CRSwNP-AAI n = 18), CRSwNP with asthma but without clinical history of analgesics intolerance (CRSwNP-A n = 20) and CRSwNP (n = 18) without asthma or analgesics intolerance (n = 18). All subjects were challenged nasally with 16 mg ASA and monitored with active anterior rhinomanometry. Rhinologic and pulmonary symptoms and standardized questionnaires scores of VAS-scores, RSOM-31 and SF-36 were correlated with rhinomanometric data following nasal challenges.

Results:

Nasal ASA challenge detected N-ERD in 96.7% of CRSwNP-AAI patients and 45% of CRSwNP-A patients. No N-ERD was detected in the CRSwNP group. The control grade of asthma measured with ACT-scores was significantly lower in the groups CRSwNP-AAI (MV 18.22) and CRSwNP-A (MV 19.75), when compared to the CRSwNP group (MV 24.39) (p = 0.000). No correlation was found between rhinologic and pulmonary parameters, nasal symptoms and the severity of nasal ASA challenges. Patients with N-ERD and uncontrolled asthma were safely challenged nasally with ASA.

Conclusion:

Nasal challenge with ASA positively confirmed the N-ERD diagnosis. The severity of reaction to ASA challenge was independent from the grade of N-ERD regarding patients with controlled and uncontrolled asthma.

Publication History

Publication Date:
18 April 2018 (online)