Quality, Safety & Informatics Group, Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, UK.
Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee, UK.
Allergy. 2015 Jul;70(7):828-35. doi: 10.1111/all.12629. Epub 2015 May 7.
The prevalence and mean provocative dose of oral aspirin (MPDA) triggering respiratory reactions in people with asthma have been inconsistently reported, and the relationship between NSAID-exacerbated respiratory disease (NERD) and asthma morbidity was less well quantified.
A systematic review was performed by identifying studies diagnosing NERD using blinded, placebo-controlled oral provocation challenge tests (OPCTs) or by self-reported history in people with asthma. Data were extracted, and effect estimates for changes in respiratory function, MPDA and asthma morbidity were pooled using random-effects meta-analysis.
The prevalence of NERD in adults with asthma was 9.0% (95% CI 6-12%) using OPCTs and 9.9% (95% CI 9.4-10.5%) using self-reported history from questionnaires. The MPDA in adults with NERD was 85.8 mg (95% CI 73.9-97.6). In people with NERD, the risk of: uncontrolled asthma was increased twofold (RR 1.96 (95% CI 1.25-3.07)); severe asthma and asthma attacks was increased by 60% (RR 1.58 (95% CI 1.15-2.16) and RR 1.59 (95% CI 1.21-2.09), respectively); emergency room visits was increased by 80% (RR 1.79 (95% CI 1.29-2.49)); and asthma hospitalization was increased by 40% (RR 1.37 (95% CI 1.12-1.67)) compared to people with NSAID-tolerant asthma.
Respiratory reactions triggered by oral aspirin in people with asthma are relatively common. At the population level, the prevalence of NERD was similar when measured using appropriately conducted OPCTs or by self-reported history. On average, respiratory reactions were triggered by clinically relevant doses of oral aspirin. Asthma morbidity was significantly increased in people with NERD who potentially require more intensive monitoring and follow-up.
哮喘患者口服阿司匹林（MPDA）引发呼吸道反应的患病率和平均激发剂量报道不一致，非甾体抗炎药（NSAID）加重的呼吸道疾病（NERD）与哮喘发病率之间的关系也没有得到很好的量化。
通过识别使用盲法、安慰剂对照口服激发试验（OPCT）或通过哮喘患者的自我报告病史诊断 NERD 的研究，进行系统评价。提取数据，并使用随机效应荟萃分析汇总呼吸功能、MPDA 和哮喘发病率变化的效应估计值。
使用 OPCT 诊断成年人哮喘患者中 NERD 的患病率为 9.0%（95%CI 6-12%），使用自我报告的问卷病史为 9.9%（95%CI 9.4-10.5%）。NERD 成年人的 MPDA 为 85.8mg（95%CI 73.9-97.6）。在 NERD 患者中，以下风险增加了两倍：未控制的哮喘（RR 1.96（95%CI 1.25-3.07））；严重哮喘和哮喘发作增加了 60%（RR 1.58（95%CI 1.15-2.16）和 RR 1.59（95%CI 1.21-2.09））；急诊室就诊增加了 80%（RR 1.79（95%CI 1.29-2.49））；哮喘住院增加了 40%（RR 1.37（95%CI 1.12-1.67）），与 NSAID 耐受哮喘患者相比。
哮喘患者口服阿司匹林引发的呼吸道反应较为常见。在人群水平上，使用适当进行的 OPCT 或自我报告的病史测量时，NERD 的患病率相似。平均而言，呼吸道反应是由临床相关剂量的口服阿司匹林引发的。NERD 患者哮喘发病率显著增加，可能需要更密切的监测和随访。
