Complete endoscopic sinus surgery followed by aspirin desensitization is associated with decreased overall corticosteroid use

Abstract

Background Aspirin‐exacerbated respiratory disease (AERD) is an aggressive respiratory tract inflammatory disorder manifesting as asthma, chronic rhinosinusitis with nasal polyposis, and a respiratory sensitivity to aspirin and nonsteroidal anti‐inflammatory drugs (NSAIDs). Corticosteroids, both systemic and topical/inhaled, are used to treat inflammation of the upper and lower airways. Our objective was to examine the potential impact of complete endoscopic sinus surgery (ESS) and aspirin desensitization (AD) on short‐term and long‐term corticosteroid use. Methods For this pilot study, a retrospective chart review of all patients with AERD who underwent ESS followed by AD was performed. Daily prednisone use, average daily prednisone dose, and inhaled corticosteroid use were analyzed at the following time points: preoperative, postoperative/pre‐AD, and 2 to 3 months, 4 to 6 months, 7 to 12 months, and 13 to 24 months following AD. Results A total of 125 patients underwent ESS followed by AD. Compared to preoperatively, patients who underwent ESS and AD were less likely to be on daily prednisone at all time points and upon long‐term follow‐up (32% preoperatively vs 10% at 13 to 24 months, McNemar's test = 9.00, p = 0.009). Average daily prednisone dose decreased from 10.6 ± 7.9 mg preoperatively to 3.8 ± 2.6 mg at 13 to 24 months following AD (Mann‐Whitney U; W = 122, p = 0.01). Similarly, high‐dose and medium‐dose inhaled corticosteroid use decreased from 18% to 7% and from 36% to 22% respectively (Pearson's chi‐square = 8.06, p = 0.05). Conclusion In our AERD cohort who underwent ESS followed by AD, there was an observed decrease in overall systemic and topical/inhaled corticosteroid use. These findings can have implications for treatment given the potentially hazardous side effects of corticosteroid use.

Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease Based on the 12-Item Short Form Survey

“…It is well known that surgery and subsequent aspirin desensitization improves respiratory symptoms and sense of smell, slows polyp regrowth, reduces need for revision surgery, and decreases topical and oral corticosteroid use. 4–6,24,25 In combination with previously published data on improved sinonasal outcomes, 4,25–27 this SF-12 study highlights how ESS and AD can also lead to an improvement in overall physical burden and social function for AERD patients. The improvements in the SF-12 scores within our AERD cohort are mirrored by their SNOT-22 scores.…”

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Corticosteroids, either topical or oral, are a proven intervention for the primary management of CRSwNP, which is characterized by continual production of inflammatory mediators and polyp formation. Ensuring effective topical delivery within the paranasal sinus cavity is fundamental to the long‐term management of CRSwNP 1077,1667 …”

“…First generation low‐volume devices such as drops, sprays, and nebulizers are an acceptable alternative if nasal cavity or limited sinus delivery is needed, but should not play a significant role in the management of CRSwNP as they do not reliably reach within the sinuses and provide no mechanism for lavage. However, second generation systems using pulsating aerosols or exhalation delivery systems to appear to provide significant deposition of drug to operated sinuses, but do not provide the additional benefit of lavage 1085,1267–1269,1272–1279,1667 …”

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

“…Patients with higher baseline serum IgE levels especially benefited from ESS performed shortly before ATAD ( 38 ). The combination of ESS and ATAD also decreased overall topical corticosteroid and OSC use ( 38 , 39 ).…”