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Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease.
J Allergy Clin Immunol Pract. 2017 Jul - Aug; 5(4):1061-1070.e3.JA

Abstract

BACKGROUND

Aspirin-exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 (COX-1) enzyme. The prevalence of AERD remains unclear, and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone, asthma alone, or both CRSwNP and asthma.

OBJECTIVE

To determine the prevalence of AERD within a tertiary care setting, and to identify unique clinical features that could distinguish these patients from those with both CRSwNP and asthma or with CRSwNP alone.

METHODS

Electronic medical records of patients at Northwestern in Chicago, Illinois, were searched by computer algorithm and then manual chart review to identify 459 patients with CRSwNP alone, 412 with both CRSwNP and asthma, 171 with AERD, and 300 with asthma only. Demographic and clinical features including sex, atopy, and sinus disease severity were characterized.

RESULTS

The prevalence of AERD among patients with CRSwNP was 16%. Patients with AERD had undergone 2-fold more sinus surgeries (P < .001) and were significantly younger at the time of their first surgery (40 ± 13 years) than were patients with CRSwNP (43 ± 14 years; P < .05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in patients with CRSwNP (66%, P < .05). More patients with AERD (13%) had corticosteroid-dependent disease than patients with both CRSwNP and asthma (4%, P < .01) or asthma (1%, P < .001).

CONCLUSIONS

AERD is common among patients with CRSwNP; even though patients with AERD have CRSwNP and asthma, the clinical course of their disease is not the same as of patients who have CRSwNP and asthma but are tolerant to COX-1 inhibitors.

Authors+Show Affiliations

Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: whitney-stevens@northwestern.edu.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.Center for Health Research, Geisinger Health System, Danville, Pa.Center for Health Research, Geisinger Health System, Danville, Pa.Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.Center for Health Research, Geisinger Health System, Danville, Pa.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28286156

Citation

Stevens, Whitney W., et al. "Clinical Characteristics of Patients With Chronic Rhinosinusitis With Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease." The Journal of Allergy and Clinical Immunology. in Practice, vol. 5, no. 4, 2017, pp. 1061-1070.e3.
Stevens WW, Peters AT, Hirsch AG, et al. Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract. 2017;5(4):1061-1070.e3.
Stevens, W. W., Peters, A. T., Hirsch, A. G., Nordberg, C. M., Schwartz, B. S., Mercer, D. G., Mahdavinia, M., Grammer, L. C., Hulse, K. E., Kern, R. C., Avila, P., & Schleimer, R. P. (2017). Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease. The Journal of Allergy and Clinical Immunology. in Practice, 5(4), 1061-e3. https://doi.org/10.1016/j.jaip.2016.12.027
Stevens WW, et al. Clinical Characteristics of Patients With Chronic Rhinosinusitis With Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract. 2017 Jul - Aug;5(4):1061-1070.e3. PubMed PMID: 28286156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease. AU - Stevens,Whitney W, AU - Peters,Anju T, AU - Hirsch,Annemarie G, AU - Nordberg,Cara M, AU - Schwartz,Brian S, AU - Mercer,Dione G, AU - Mahdavinia,Mahboobeh, AU - Grammer,Leslie C, AU - Hulse,Kathryn E, AU - Kern,Robert C, AU - Avila,Pedro, AU - Schleimer,Robert P, Y1 - 2017/03/09/ PY - 2016/07/08/received PY - 2016/11/28/revised PY - 2016/12/20/accepted PY - 2017/3/14/pubmed PY - 2018/2/1/medline PY - 2017/3/14/entrez KW - AERD KW - Asthma KW - CRS KW - CRSwNP KW - Samter's disease KW - Sinus SP - 1061 EP - 1070.e3 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 5 IS - 4 N2 - BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 (COX-1) enzyme. The prevalence of AERD remains unclear, and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone, asthma alone, or both CRSwNP and asthma. OBJECTIVE: To determine the prevalence of AERD within a tertiary care setting, and to identify unique clinical features that could distinguish these patients from those with both CRSwNP and asthma or with CRSwNP alone. METHODS: Electronic medical records of patients at Northwestern in Chicago, Illinois, were searched by computer algorithm and then manual chart review to identify 459 patients with CRSwNP alone, 412 with both CRSwNP and asthma, 171 with AERD, and 300 with asthma only. Demographic and clinical features including sex, atopy, and sinus disease severity were characterized. RESULTS: The prevalence of AERD among patients with CRSwNP was 16%. Patients with AERD had undergone 2-fold more sinus surgeries (P < .001) and were significantly younger at the time of their first surgery (40 ± 13 years) than were patients with CRSwNP (43 ± 14 years; P < .05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in patients with CRSwNP (66%, P < .05). More patients with AERD (13%) had corticosteroid-dependent disease than patients with both CRSwNP and asthma (4%, P < .01) or asthma (1%, P < .001). CONCLUSIONS: AERD is common among patients with CRSwNP; even though patients with AERD have CRSwNP and asthma, the clinical course of their disease is not the same as of patients who have CRSwNP and asthma but are tolerant to COX-1 inhibitors. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/28286156/Clinical_Characteristics_of_Patients_with_Chronic_Rhinosinusitis_with_Nasal_Polyps_Asthma_and_Aspirin_Exacerbated_Respiratory_Disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(17)30005-3 DB - PRIME DP - Unbound Medicine ER -