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

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.

Using machine learning for personalized prediction of revision paranasal sinus surgery

“…CRSwNP patients with co-morbid asthma and/or NERD have an increased risk for recurrence and revision ESS, although these patients seem benefit from initial ESS 13,19,[25][26][27] . This may reflect a more severe disease, with usually co-morbid NERD, anosmia, Type 2 high eosinophilic inflammation, and a greater tendency of polyp re-growth 23,[28][29][30][31][32][33][34][35][36][37] . When performing SFS, Immunodeficiency or its suspicion showed also to one of the top ten predictors by all three classifiers.…”

Pathophysiological and Clinical Aspects of Chronic Rhinosinusitis: Current Concepts

“…However, discontinuation of this therapy hampers correct long-term evaluation and still questions its actual value ( 122 ). A recent retrospective study concluded that nasal polyp eosinophilia, the frequent need of oral corticosteroid courses and a history of recurrent CRSwNP surgery were consistent factors predicting uncontrolled N-ERD ( 123 ).…”

Baseline Conservative and Surgical Management in the Treatment of NSAID-Exacerbated Respiratory Disease

“…It has been shown that extended ESS reduces symptom scores among patients with CRS ( 23 ) and the need for revision surgery compared with partial ESS ( 24 ). A recent study has shown that partial ethmoidectomy in patients with N-ERD increased the risk of revision surgery ( 25 ). Furthermore, recurrent ESS surgeries predicted uncontrolled N-ERD ( 25 ).…”

“…A recent study has shown that partial ethmoidectomy in patients with N-ERD increased the risk of revision surgery ( 25 ). Furthermore, recurrent ESS surgeries predicted uncontrolled N-ERD ( 25 ). ESS reduces patients' symptoms reported in the SNOT-22 scores, and this effect is also objectively seen in improvement in nasal endoscopy and CT scans postoperatively in patients with N-ERD ( 26 ).…”