Longitudinal progression of aspirin‐exacerbated respiratory disease: analysis of a national insurance claims database

Abstract

Background: Aspirin-exacerbated respiratory disease (AERD) is a recalcitrant inflammatory disorder defined by asthma, nasal polyposis, and sensitivity to cyclooxygenase-1 inhibitors. The timeline and course of disease progression is unclear. Methods:The Truven MarketScan Database, a large American health insurance claims repository, was queried to identify patients meeting criteria for AERD from 2009 to 2015. Included patients had associated International Classification of Diseases, 9th edition (ICD-9) codes consistent with all 3 components of AERD: asthma, nasal polyposis, and drug allergy. Pa erns of disease onset and time to progression were analyzed. Results:A total of 5628 patients were identified for study inclusion. Of the 3 components of AERD, 3303 patients (59%) were initially diagnosed with asthma, 1408 (25%) were initially diagnosed with nasal polyps, and 917 (16%) were first diagnosed with drug sensitivity. The most common (36%) sequence of diagnoses was asthma, followed by nasal polyps, followed by drug allergy. The median interval between diagnosis of upper or lower airway involvement (ie, nasal polyps and/or asthma) to recognition of drug sensitivity was 259 days (quartiles Q1 to Q3: 92 to 603 days). In patients with both asthma and nasal polyps diagnoses, the risk of developing drug sensitivity during the study time period was 6%. Conclusion:Upper and lower airway disease is o en initially recognized in patients with AERD, whereas drug sensitivity presents month to years later. This delay may be due to the pathophysiology of AERD and disease progression or due to practice pa erns in diagnostic testing and coding. Further work is warranted to identify these patients at early stages in their disease progression. C 2019 ARS-AAOA, LLC.

Treatment practices for aspirin‐exacerbated respiratory disease: analysis of a national insurance claims database

“…Patients meeting criteria had ICD‐9 diagnosis codes consistent with all 3 components of AERD: asthma, nasal polyposis, and drug allergy; patients with ICD‐9 codes for other lung diseases and immunodeficiency were excluded. This query was performed using previously published methodology . Because aspirin allergy is not represented by a designated ICD‐9 code, drug allergy ICD‐9 codes were used as surrogate codes for this analysis.…”

“…This query was performed using previously published methodology. 6 Because aspirin allergy is not represented by a designated ICD-9 code, drug allergy ICD-9 codes were used as surrogate codes for this analysis. CPT codes for drug desensitization and endoscopic endonasal procedures were used to determine treatments received during the study time period.…”

Guidance for contemporary use of biologics in management of chronic rhinosinusitis with nasal polyps: discussion from a National Institutes of Health–sponsored workshop

“…At the present time, our treatment paradigm of medical therapy includes the off‐label use of high‐volume saline irrigations, topical nasal steroid delivery, and oral steroids and antibiotics as indicated 12 . In the workup of CRSwNP, it is important to evaluate for comorbidities and clinical features that suggest a specific CRSwNP endotype such as AERD or AFRS 33 . Management of comorbid asthma is critical during the medical treatment of CRS.…”

Aspirin‐exacerbated respiratory disease: personalized medical and surgical approaches

“…Delay in diagnosis has been associated with increased systemic steroid use, 4 thus additional clinical factors may alert the astute physician to the presence of AERD. There is conflicting information regarding development of upper or lower airway symptoms first 3,5 ; however, aspirin or nonsteroidal sensitivity is typically the last component to present and may go unrecognized. Alcohol sensitivity may be present in up to 75% of AERD patients.…”