Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):1061-1070.e3. doi: 10.1016/j.jaip.2016.12.027. Epub 2017 Mar 9.
Aspirin-exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 (COX-1) enzyme. The prevalence of AERD remains unclear, and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone, asthma alone, or both CRSwNP and asthma.
To determine the prevalence of AERD within a tertiary care setting, and to identify unique clinical features that could distinguish these patients from those with both CRSwNP and asthma or with CRSwNP alone.
Electronic medical records of patients at Northwestern in Chicago, Illinois, were searched by computer algorithm and then manual chart review to identify 459 patients with CRSwNP alone, 412 with both CRSwNP and asthma, 171 with AERD, and 300 with asthma only. Demographic and clinical features including sex, atopy, and sinus disease severity were characterized.
The prevalence of AERD among patients with CRSwNP was 16%. Patients with AERD had undergone 2-fold more sinus surgeries (P < .001) and were significantly younger at the time of their first surgery (40 ± 13 years) than were patients with CRSwNP (43 ± 14 years; P < .05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in patients with CRSwNP (66%, P < .05). More patients with AERD (13%) had corticosteroid-dependent disease than patients with both CRSwNP and asthma (4%, P < .01) or asthma (1%, P < .001).
AERD is common among patients with CRSwNP; even though patients with AERD have CRSwNP and asthma, the clinical course of their disease is not the same as of patients who have CRSwNP and asthma but are tolerant to COX-1 inhibitors.
阿司匹林加重的呼吸道疾病（AERD）包括慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）、哮喘以及对环氧化酶-1（COX-1）酶抑制剂不耐受三联征。AERD 的患病率尚不清楚，并且很少有研究比较 AERD 患者与单纯 CRSwNP、单纯哮喘或同时患有 CRSwNP 和哮喘患者的临床特征。
确定三级医疗机构中 AERD 的患病率，并确定可将这些患者与同时患有 CRSwNP 和哮喘或单纯 CRSwNP 的患者区分开来的独特临床特征。
通过计算机算法和手动病历审查，对伊利诺伊州芝加哥西北大学的患者电子病历进行检索，以确定 459 例单纯 CRSwNP 患者、412 例同时患有 CRSwNP 和哮喘患者、171 例 AERD 患者和 300 例单纯哮喘患者。对包括性别、过敏和鼻窦疾病严重程度在内的人口统计学和临床特征进行了描述。
CRSwNP 患者中 AERD 的患病率为 16%。AERD 患者接受鼻窦手术的次数多了 2 倍（P <.001），并且首次手术时的年龄明显小于 CRSwNP 患者（40 ± 13 岁）（P <.05）。AERD 患者（84%）或哮喘患者（85%）的过敏率明显高于 CRSwNP 患者（66%，P <.05）。与同时患有 CRSwNP 和哮喘（4%，P <.01）或哮喘（1%，P <.001）的患者相比，更多的 AERD 患者（13%）患有依赖皮质类固醇的疾病。
AERD 在 CRSwNP 患者中很常见；尽管 AERD 患者同时患有 CRSwNP 和哮喘，但他们的疾病病程与对 COX-1 抑制剂耐受的同时患有 CRSwNP 和哮喘的患者不同。
