Diagnostic Value of Clinical Parameters in the Prediction of Aspirin-Exacerbated Respiratory Disease in Asthma

Abstract

PurposeAspirin-exacerbated respiratory disease (AERD) has attracted a great deal of attention because of its association with increased asthma severity. However, oral aspirin challenge (OAC) to diagnose AERD is a time-consuming procedure, and some patients experience serious complications. Thus, we evaluated diagnostic values of non-invasive clinical parameters to predict AERD in asthmatic patients.MethodsA total of 836 Korean subjects were recruited from an asthma cohort. They underwent OAC, and clinical parameters including the history of aspirin hypersensitivity, nasal polyposis, and chronic sinusitis of aspirin-tolerant asthma (ATA) and AERD asthmatic patients were compared.ResultsSignificant differences (P<0.01) were found in eight parameters: age at diagnosis, body mass index, FEV1%, PC20, history of urticaria, nasal polyps, chronic sinusitis, and history of aspirin hypersensitivity. After logistic regression analysis based on the eight clinical parameters, nasal polyps, history of aspirin intolerance, sinusitis, and log [PC20 methacholine] remained significantly associated with AERD (P<0.05). The sensitivity and specificity of the history of aspirin hypersensitivity to predict AERD were 64.7% and 92.0%, respectively, and the positive and negative predictive values were 56.9% and 94.1%, respectively. Overall, the accuracy of the test was 88.2%. The accuracy of the tests for nasal polyps and chronic sinusitis were 67.3% and 60.4%, respectively.ConclusionsAmong clinical parameters associated with AERD, the history of aspirin hypersensitivity has the best positive and negative predictive values for the oral aspirin challenge test. Because the false-positive and -negative rates were still high, additional non-invasive methods are needed to reduce the rate of false outcomes.

Single Nucleotide Polymorphisms in TNF are Associated with Susceptibility to Aspirin-exacerbated Respiratory Disease but not to Cytokine Levels: a Study in Mexican Mestizo Population

“…This is a lower data that previously reported by Jenkins et al [1]; however, the patients' clinical characteristics are similar to those described by Szcezclick in an Eastern European population [17]. Nevertheless, the Mexican population presents distinct characteristics compared with those of the Asian population, such as a lower concentration of IgE [18] and higher concentration of eosinophils in the blood [4].…”

“…AERD is a disease characterized by restructuring of the airway [2] and the presence of extensive hyperplastic eosinophilic sinusitis with the formation of nasal polyps [3]. The most important clinical characteristic is bronchoconstriction after the administration of aspirin (ASA) or other nonsteroidal anti-inflammatory drugs (NSAIDs) [2,4]. The physiopathology involves a block in the cyclooxygenase pathway that promotes a diversion of arachidonic acid metabolism toward the lipoxygenase pathway, inducing the synthesis of leukotrienes such as LTC4, LTD4 and LTE4 [5,6], proteins that induce inflammatory cell chemotaxis, and the release of cytokines such as TNF-α [7] and lymphotoxin.…”

Association analysis of tapasin polymorphisms with aspirin-exacerbated respiratory disease in asthmatics

“…The asthmatic patients had experienced no exacerbation of asthma or respiratory tract infection in the 6 weeks preceding oral aspirin challenge (OAC). OAC was performed in all patients with increasing doses of aspirin using methods slightly modified from those described previously [19,20]. Briefly, patients with a history of aspirin hypersensitivity were administered a dose of 30 mg and those with no history were started on 100 mg of aspirin orally.…”

Association analysis of formyl peptide receptor 2 (FPR2) polymorphisms and Aspirin exacerbated respiratory diseases

“…This syndrome is characterized by the 'aspirin triad,' which consists of aspirin hypersensitivity, bronchial asthma, nasal polyposis and chronic hyperplastic eosinophilic sinusitis. [1][2][3] Similar to other asthmatic individuals, the airways of patients with AERD show signs of persistent inflammation with marked eosinophilia, epithelial disruption, cytokine production and upregulation of inflammatory molecules. 4 Overproduction or underproduction of critical modulators important for the metabolism of arachidonic acids, including leukotrienes, lipoxins, thromboxane and prostaglandins, likely accounts for the observed susceptibility to aspirin.…”