scholarly journals Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease: an evidence-based review with recommendations

2016 ◽  
Vol 6 (12) ◽  
pp. 1273-1283 ◽  
Author(s):  
Joshua M. Levy ◽  
Luke Rudmik ◽  
Anju T. Peters ◽  
Sarah K. Wise ◽  
Brian W. Rotenberg ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Nasal Polyposis ◽  
Evidence Based ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Contemporary Management

Dupilumab as Add-on Therapy for Chronic Rhinosinusitis With Nasal Polyposis in Aspirin Exacerbated Respiratory Disease

2020 ◽  
pp. 194589242096196
Author(s):  
S. Shahzad Mustafa ◽  
Karthik Vadamalai ◽  
Bryan Scott ◽  
Allison Ramsey
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Nasal Polyposis ◽  
Total Serum ◽  
Life Questionnaire ◽  
Median Baseline ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Snot 22

Background Aspirin-exacerbated respiratory disease (AERD) affects 7% of asthmatics. Usual therapies are inadequate for asthma and/or nasal polyposis, leading to decreased quality of life. Objective Our objective was to evaluate the efficacy of dupilumab in AERD patients with uncontrolled, chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods Patients 18 years and older with a physician diagnosis of AERD and sino-nasal outcome test 22 (SNOT 22) score ≥19 despite standard medical therapy were eligible for the study. Patients received one month of placebo dosing, followed by 6 months of dupilumab. Patients were blinded to the order of therapy. Wilcoxon-paired rank sum test was used to compare study outcomes at baseline and the completion of the study. Results Ten patients completed the study. The median baseline SNOT 22 score improved from 46 [IQR: 34 to 64.8] to 9.5 [IQR: 2.5 to 19] after 6 months of therapy (p = 0.0050). The median baseline Lund MacKay score improved from 21.5 [IQR: 17 to 23.3] to 4 [IQR: 1.2 to 6] after 6 months of therapy (p = 0.0050). There was also improvement in the following secondary outcomes: asthma control test (ACT), mini asthma quality of life questionnaire (AQLQ), and University of Pennsylvania Smell Identification test (UPSIT). Exhaled nitric oxide (FeNO), total serum IgE, 24-hour urinary leukotriene E4, and serum thymus and activation regulated cytokine (TARC) also decreased. There were no significant study-related adverse events. Conclusion Dupilumab was highly effective as add-on therapy for CRSwNP in AERD, improving patient-reported outcomes, sinus opacification, and markers of T2 inflammation.

scholarly journals Aspirin Sensitivity and Chronic Rhinosinusitis with Polyps: A Fatal Combination

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Hendrik Graefe ◽  
Christina Roebke ◽  
Dirk Schäfer ◽  
Jens Eduard Meyer
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Clinical Features ◽  
Nasal Polyposis ◽  
Molecular Mechanisms ◽  
Molecular Pathogenesis ◽  
Surgical Interventions ◽  
Aspirin Sensitivity ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Lower Airways

Aspirin-exacerbated respiratory disease (AERD) refers to aspirin sensitivity, chronic rhinosinusitis (CRS), nasal polyposis, asthma, eosinophil inflammation in the upper and lower airways, urticaria, angioedema, and anaphylaxis following the ingestion of NSAIDs. Epidemiologic and pathophysiological links between these diseases are established. The precise pathogenesis remains less defined, even though there is some progress in the understanding of several molecular mechanisms. Nevertheless, these combinations of diseases in patients classified by AERD constitute a fatal combination and may be difficult to treat with standard medical and surgical interventions. This paper reviews in brief the epidemiology, clinical features, diagnosis, molecular pathogenesis, and specific therapies of patients classified by AERD and postulates future attempts to gain new insights into this disease.

An Update on the Epidemiology of Aspirin-Exacerbated Respiratory Disease

2017 ◽  
Vol 31 (5) ◽  
pp. 299-301 ◽  
Author(s):  
Andrew A. White
Keyword(s):  
Respiratory Disease ◽  
Diagnostic Test ◽  
Clinical Studies ◽  
Nasal Polyposis ◽  
Aspirin Therapy ◽  
Population Characteristics ◽  
Sinus Disease ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Cyclooxygenase 1 ◽  
Specific Evaluation

Background Aspirin-exacerbated respiratory disease (AERD) is a disorder of nasal polyposis, asthma, and hypersensitivity respiratory reactions when on systemic cyclooxygenase 1 blockade. Methods AERD Warrants Specific Evaluation As An Endotype Of Asthma And Chronic Sinus Disease Due To Unique Therapeutic Opportunities. Currently, Aspirin Therapy Is Uniquely Beneficial As An Anti-Inflammatory Therapy In Aerd, With Multiple Additional Therapies Currently In Early To Late Clinical Studies, Which Might Also Show Exceptional Benefit In AERD. Results Yet, given the lack of a simple diagnostic test, opportunities to identify patients with AERD are still frequently neglected. Conclusion Identifying the prevalence and population characteristics necessary to determine appropriate candidates in whom to perform diagnostic aspirin challenge remains critically important and was the purpose of this article.

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