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 CRSwNP+Asthma or CRSwNP.
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 CRSwNP+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 CRSwNP patients was 16%. AERD patients had undergone two-fold more sinus surgeries (p<0.001) and were significantly younger at the time of their first surgery (40±13 years) than CRSwNP patients (43±14 years, p<0.05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in CRSwNP (66%, p<0.05). More patients with AERD (13%) had corticosteroid-dependent disease than CRSwNP+Asthma (4%, p<0.01) or asthma (1%, p<0.001).
Conclusions
AERD is common among CRSwNP patients; even though AERD patients 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.