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. 2021 Mar;9(1):80-89.
doi: 10.1002/iid3.347. Epub 2021 Jan 5.

Factors affecting upper airway control of NSAID-exacerbated respiratory disease: A real-world study of 167 patients

Annina Lyly  1   2 , Anu Laulajainen-Hongisto  1   2 , Heikki Turpeinen  1 , Seija I Vento  2 , Jyri Myller  3 , Jura Numminen  4 , Saara Sillanpää  4 , Johanna Sahlman  5 , Paula Kauppi  1 , Sanna Toppila-Salmi  1   6
Affiliations

Factors affecting upper airway control of NSAID-exacerbated respiratory disease: A real-world study of 167 patients

Annina Lyly et al. Immun Inflamm Dis. 2021 Mar.

Abstract

Background: Nonsteroidal 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.

Methods: Retrospective 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.

Results: Nasal 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.

Conclusions: Nasal 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.

Keywords: CRS; N-ERD; asthma; disease control; eosinophilia; nasal polyps.

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Conflict of interest statement

Sanna Toppila‐Salmi reports a grant of GSK and consultancies for ERT, Novartis, Sanofi Pharma, and Roche Products outside the submitted work. Anu Laulajainen‐Hongisto reports a grant from the Orion Research Foundation, outside of the submitted work. The other authors declare that there are no conflict of interests.

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