Inflammation Center, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Immun Inflamm Dis. 2021 Mar;9(1):80-89. doi: 10.1002/iid3.347. Epub 2021 Jan 5.
Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) is a triad with asthma, chronic rhinosinusitis with nasal polyps, and NSAID intolerance. Uncontrolled N-ERD forms a major public health problem due to frequent and difficult-to-treat exacerbations and/or requiring putatively frequent endoscopic sinus surgeries (ESS). Our aim was to study factors affecting control of N-ERD.
Retrospective patient record data (patient characteristics, prior sinus surgeries, follow-up data in 2020) from 167 N-ERD patients undergoing consultation at three tertiary hospitals from 2001 to 2017 was used. Outcome measurements reflecting uncontrolled N-ERD were revision ESS, corticosteroids/biological therapy, and antibiotic courses during 2016-2020. Associations were analyzed by using nonparametric tests, Cox's proportional hazard, and binary logistic regression models.
Nasal polyp eosinophilia increased the risk of revision surgery during the follow-up (adjusted hazard ratio [aHR] 3.21, confidence interval 1.23-8.38). Also baseline oral corticosteroids (OCS; HR, 1.73, 1.04-2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07-4.42) in unadjusted models. In addition, both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23-6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98-4.70) were associated with the use of OCS/biological therapy during the follow-up, but not with high number of antibiotics.
Nasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N-ERD. These factors might be clinically useful in risk-estimation of uncontrolled disease and for organizing follow-ups. Prospective cohort studies with larger sample size are needed to further study the factors affecting the upper airway control of N-ERD.
非甾体抗炎药（NSAID）加重的呼吸道疾病（N-ERD）是一种三联症，包括哮喘、慢性鼻-鼻窦炎伴鼻息肉和 NSAID 不耐受。由于频繁且难以治疗的加重和/或需要潜在频繁的内镜鼻窦手术（ESS），未控制的 N-ERD 构成了一个主要的公共卫生问题。我们的目的是研究影响 N-ERD 控制的因素。
回顾性分析了 2001 年至 2017 年期间在三家三级医院就诊的 167 例 N-ERD 患者的病历数据（患者特征、既往鼻窦手术、2020 年随访数据）。反映未控制 N-ERD 的结局测量包括 2016-2020 年期间的 ESS 修订、皮质类固醇/生物治疗和抗生素疗程。使用非参数检验、Cox 比例风险和二项逻辑回归模型分析相关性。
鼻息肉嗜酸性粒细胞增多增加了随访期间手术修订的风险（调整后的危险比 [aHR] 3.21，95%置信区间 1.23-8.38）。基线口服皮质类固醇（OCS；HR，1.73，1.04-2.89）和无全筛窦切除术的基线手术也增加了 ESS 修订的风险（HR，2.17，1.07-4.42），在未调整模型中。此外，基线 OCS（调整后的优势比 [aOR] 2.78，1.23-6.26）和≥4 次既往 ESS 史（aOR，2.15，0.98-4.70）与随访期间使用 OCS/生物治疗相关，但与抗生素使用次数无关。
鼻息肉嗜酸性粒细胞增多、基线 OCS 和 ESS 复发史预测未控制的 N-ERD。这些因素可能在未控制疾病的风险估计和随访安排方面具有临床意义。需要更大样本量的前瞻性队列研究来进一步研究影响 N-ERD 上呼吸道控制的因素。
