Objective and subjective sinonasal and pulmonary outcomes in aspirin desensitization therapy: A prospective cohort study. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Cooper, Timothy; Greig, Samuel R.; Zhang, Han; Seemann, Robert; Wright, Erin D.; Vliagoftis, Harissios; Côté, David W.J.
• Is Part Of: Auris nasus larynx. Volume 46:Issue 4(2019)
• Page Start: 526
• Page End: 532
• Publication Date: 2019-08
• Subjects: ACQ Asthma Control Questionnaire -- AERD aspirin exacerbated respiratory disease -- ASA aspirin -- CRSwNP chronic rhinosinusitis with nasal polyposis -- FEV1 force expiratory volume 1 second -- IQR interquartile range -- POSE perioperative sinus endoscopy scoring system -- SNOT-20 Sinonasal Outcome Test-20 -- SNOT-22 Sinonasal Outcome Test-22; Aspirin -- Samter's triad -- Aspirin exacerbated respiratory disease -- Asthma -- Nasal polyposis -- Chronic rhinosinusitis; Otolaryngology -- Periodicals; Electronic journals; 616
• DOI: 10.1016/j.anl.2018.12.002
• Languages: English
• ISSNs: 0385-8146

Abstract

Abstract: Objective: Aspirin exacerbated respiratory disease (AERD) patients are challenging to manage with sinonasal and pulmonary symptoms refractory to maximal medical and surgical therapies. Our objective was to comprehensively examine objective and validated, disease-specific subjective sinonasal and pulmonary outcomes of aspirin (ASA) desensitization therapy in this patient population. Methods: Prospective cohort study at an academic tertiary center. AERD patients with a history of chronic rhinosinusitis with nasal polyposis (CRSwNP), prior diagnosis of asthma, and a history of ASA sensitivity were eligible for inclusion. Patients underwent ASA desensitization using an established institutional protocol and continued on a 650 mg twice daily maintenance dose. Baseline Sinonasal Outcome Test (SNOT-22) and Asthma Control Questionnaire (ACQ) responses, acoustic rhinometry, peak flow readings, and endoscopic scoring of nasal polyps were recorded prior to desensitization and after 6 months of maintenance therapy. Results: Twelve patients were recruited for participation and underwent desensitization. Eight patients continued maintenance therapy and follow up at 6 months. Prior to desensitization, patients reported bothersome sinonasal symptoms with a median SNOT-22 score of 30.0 ± 34.5 (interquartile range (IQR)). There was significant improvement after 6 months of maintenance therapy to a median SNOT-22 score of 18.5 ± 17.3 (p = 0.025, Wilcoxon signed rank test). Acoustic rhinometry, endoscopic scores, ACQ and forced expiratory volume values remained stable at 6 months. Conclusions: AERD patients may benefit from ASA desensitization with subjective sinonasal symptom improvement at 6 months and stable asthma and objective sinonasal measures. Further discussion is needed in the otolaryngology community regarding ASA desensitization in AERD management.