Objective and subjective sinonasal and pulmonary outcomes in aspirin desensitization therapy: A prospective cohort study |
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| Institution: | 1. Division of Otolaryngology — Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada, T6G 2B7;2. Division of Otolaryngology — Head and Neck Surgery, Department of Surgery, McMaster University, Room G811, 50 Charlton Ave, Hamilton, ON, Canada L8N 4A6;3. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-105 Central Services Building, Edmonton, AB, Canada;1. Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey;2. Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey;3. Department of Surgery, Batman State Hospital, Batman, Turkey;1. Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil;2. Respiratory Endoscopy and Head and Neck Surgery Service at Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil;3. Laboratory of Functional Genomics and Bioinformatics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;4. Department of Biochemistry, Institute of Biology Roberto Alcantara Gomes, State University of Rio de Janeiro, Rio de Janeiro, Brazil;5. Laboratory of Molecular Pathology, Pathological Anatomy Service, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;6. Kennedy College, Engineering and Production Department, Belo Horizonte, Brazil;7. Membrane Transport Laboratory, Department of Pharmacology and Psychobiology, Institute of Biology Roberto Alcantara Gomes, State University of Rio de Janeiro, Rio de Janeiro, Brazil;1. Department of Otorhinolaryngology Head and Neck surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan;2. Department of Otorhinolaryngology Head and Neck surgery, Niigata University Graduate School of Medical and Dental Science, 1-754 Asahimachidori, Chuo-ku, Niigata, Japan;3. Kawasaki ENT Clinic, 5-7-4-210 Imazunaka, Tsurumi-ku, Osaka, Japan;4. Department of Otorhinolaryngology Head and Neck surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-shi, Osaka, Japan;2. Başkent University Department of Medical Genetics, Sehit H. Temel Kuguoglu Avenue No:34 06490 Bahcelievler, Ankara, Turkey;1. Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Republic of Korea;2. Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea;3. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;4. Department of Oral and Maxillofacial Surgery, Dong-A University College of Medicine, Busan, Republic of Korea;5. Department of Otorhinolaryngology-Head and Neck Surgery, St. Mary’s medical Center, Busan, Republic of Korea;1. Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India;2. Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, 400012, India;3. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, 400012, India;4. Department of Medical Oncology, Tata Memorial Hospital, Mumbai, 400012, India |
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| Abstract: | ObjectiveAspirin 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.MethodsProspective 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 650 mg 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 6 months of maintenance therapy.ResultsTwelve patients were recruited for participation and underwent desensitization. Eight patients continued maintenance therapy and follow up at 6 months. 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 6 months 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 6 months.ConclusionsAERD patients may benefit from ASA desensitization with subjective sinonasal symptom improvement at 6 months and stable asthma and objective sinonasal measures. Further discussion is needed in the otolaryngology community regarding ASA desensitization in AERD management. |
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| Keywords: | Aspirin Samter’s triad Aspirin exacerbated respiratory disease Asthma Nasal polyposis Chronic rhinosinusitis |
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