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Auris Nasus Larynx. 2019 Aug;46(4):526-532. doi: 10.1016/j.anl.2018.12.002. Epub 2018 Dec 19.

Objective and subjective sinonasal and pulmonary outcomes in aspirin desensitization therapy: A prospective cohort study.

Author information

1
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7. Electronic address: tcooper@ualberta.ca.
2
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7. Electronic address: gresa1@yahoo.co.nz.
3
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, McMaster University, Room G811, 50 Charlton Ave, Hamilton, ON, Canada L8N 4A6. Electronic address: hanzhang@stjosham.on.ca.
4
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7. Electronic address: r_see_00@yahoo.ca.
5
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7. Electronic address: erin.wright@ualberta.ca.
6
Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-105 Central Services Building, Edmonton, AB, Canada. Electronic address: hari@ualberta.ca.
7
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7. Electronic address: cote@ualberta.ca.

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 650mg 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 6months of maintenance therapy.

RESULTS:

Twelve patients were recruited for participation and underwent desensitization. Eight patients continued maintenance therapy and follow up at 6months. 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 6months 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 6months.

CONCLUSIONS:

AERD patients may benefit from ASA desensitization with subjective sinonasal symptom improvement at 6months and stable asthma and objective sinonasal measures. Further discussion is needed in the otolaryngology community regarding ASA desensitization in AERD management.

KEYWORDS:

Aspirin; Aspirin exacerbated respiratory disease; Asthma; Chronic rhinosinusitis; Nasal polyposis; Samter’s triad

PMID:
30577986
DOI:
10.1016/j.anl.2018.12.002

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