Walters Kristen M, Waldram Jeremy D, Woessner Katharine M, White Andrew A
1 Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California.
Am J Rhinol Allergy. 2018 Jul;32(4):280-286. doi: 10.1177/1945892418770260. Epub 2018 Apr 23.
Background Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad or aspirin (ASA)-intolerant asthma, affects 7% of asthmatics and has a higher prevalence in those with chronic rhinosinusitis and concomitant nasal polyposis. ASA desensitization with daily ASA therapy is a uniquely beneficial treatment for this disease entity and has been shown to have a significant impact on symptom scores, polyp disease, and need for systemic corticosteroids. However, no long-term studies have demonstrated whether or not ASA therapy remains safe and beneficial for these patients beyond 5-10 years. Objective This study was designed to determine the clinical course of AERD patients desensitized between 1995 and 2010. Methods A 20-question survey was distributed to patients who successfully completed ASA desensitization between January 1995 and April 2010. The questions were designed to assess ASA safety and longitudinal effects of ASA therapy in AERD. Results Of the 285 patients contacted, 92 (32%) completed the questionnaire. Average length of follow-up was 15 years. Of survey responders, 35 patients had discontinued ASA therapy. Although adverse reactions occurred, many also discontinued due to lack of efficacy or need for surgery. For those remaining on ASA (62%), significant improvement in sense of smell, asthma, sinus, and allergic rhinitis scores were noted ( P ≤ .001). The majority of ASA patients (68%) had a positive response to treatment and did not require further sinus surgery. However, ASA therapy did not delay the time to next sinus/polyp surgery ( P = .27) or reduce total number of sinus surgeries ( P = .56) compared to those who stopped treatment. Nearly 85% of AERD patients on ASA therapy found it to be helpful in improving airway disease and quality of life. Conclusion Aspirin desensitization followed by daily maintenance ASA therapy appears to be safe and effective even after 10+ years of continuous use.
背景 阿司匹林诱发的呼吸道疾病（AERD），也称为桑特三联征或阿司匹林（ASA）不耐受性哮喘，影响7%的哮喘患者，在慢性鼻窦炎合并鼻息肉患者中的患病率更高。每日服用ASA进行脱敏治疗对这种疾病具有独特的益处，已被证明对症状评分、息肉疾病以及全身用糖皮质激素的需求有显著影响。然而，尚无长期研究表明ASA治疗在5至10年后对这些患者是否仍安全且有益。目的 本研究旨在确定1995年至2010年间接受脱敏治疗的AERD患者的临床病程。方法 向1995年1月至2010年4月成功完成ASA脱敏治疗的患者发放一份包含20个问题的调查问卷。这些问题旨在评估ASA在AERD中的安全性和长期疗效。结果 在联系的285名患者中，92名（32%）完成了问卷。平均随访时间为15年。在调查对象中，35名患者停止了ASA治疗。虽然出现了不良反应，但许多患者也是因疗效不佳或需要手术而停药。对于继续服用ASA的患者（62%），嗅觉、哮喘、鼻窦炎和过敏性鼻炎评分有显著改善（P≤0.001）。大多数服用ASA的患者（68%）对治疗有积极反应，无需进一步的鼻窦手术。然而，与停药患者相比，ASA治疗并未延迟下次鼻窦/息肉手术的时间（P = 0.27），也未减少鼻窦手术的总数（P = 0.56）。近85%接受ASA治疗的AERD患者认为其有助于改善气道疾病和生活质量。结论 即使连续使用10多年，阿司匹林脱敏后每日维持ASA治疗似乎仍是安全有效的。
