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Clinical Characteristics of Aspirin Exacerbated Respiratory Disease in a Tertiary Care Patient Cohort
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Whitney W. Stevens, MD PhD, Anju T. Peters, MD FAAAAI, Leslie C. Grammer, MD FAAAAI, Kathryn E. Hulse, PhD, Atsushi Kato, PhD, Bruce Tan, MD, Stephanie S. Smith, MD, David B. Conley, MD, Robert C. Kern, MD, Pedro C. Avila, MD, Robert P. Schleimer, PhD FAAAAI

Rationale: Aspirin exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to cyclooxygenase-1 enzyme inhibitors such as aspirin. The prevalence of AERD remains unclear and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP or asthmatics without CRS.

Methods: ICD-9 codes were used to search electronic medical records (EMR) from a tertiary care center to identify 3 distinct patient groups: 1) CRSwNP alone; 2) CRSwNP+Asthma; and 3) AERD. For comparison, 300 patients diagnosed with asthma without CRS were randomly selected from the EMR. We evaluated clinical characteristics including lung function, sinus surgeries, and oral corticosteroid use.

Results: We identified 459 patients with CRSwNP alone, 412 with CRSwNP+Asthma, and 173 with AERD. The prevalence of AERD among all CRSwNP patients was 16%. AERD patients underwent 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 (83%) or asthma (85%) than in CRSwNP (66%, p<0.05). FEV1% was significantly lower in AERD patients compared to asthmatics (80±18 vs 86±17, p<0.01). Finally, more patients with AERD (13%) had corticosteroid-dependent disease than CRSwNP+Asthma (4%, p<0.01) or asthma (1%, p<0.001).

Conclusions: This is one of the largest studies comparing surgical and non-surgical AERD patients with CRSwNP patients and asthmatics. AERD is common among CRSwNP and is associated with more severe sinus disease and reduced lung function compared to CRSwNP patients and asthmatics respectively.