阿司匹林加剧的呼吸系统疾病(AERD)是一种难以治疗的综合征,及时诊断和启动疾病特异性治疗与改善患者预后有关。
■为了描述临床三联症[哮喘,鼻息肉病,和对非甾体抗炎药(NSAIDs)的反应],识别快速诊断AERD的障碍,并描述阿司匹林挑战的适应症,以促进准确诊断。
■在BrighamandWomen医院的AERD注册中发现了六百九十七名诊断为AERD且至少有一次鼻窦手术切除鼻息肉的患者。患者报告哮喘发病时的年龄,鼻息肉病,和首次NSAID反应的年龄在2013年至2019年纳入时获得。
■在确定的697名患者中,哮喘的诊断先于鼻息肉病和首次NSAID反应的诊断,尽管患者之间存在相当大的差异。
■快速诊断AERD对于患者和提供者的教育以及改善这种难以治疗的患者群体的护理非常重要。考虑在对NSAIDs无历史反应的患者中诊断性阿司匹林攻击,这些患者具有其他相适的临床病史。特别是在每天服用低剂量阿司匹林的患者中,白三烯改性剂,避免NSAIDs,或在基线时出现严重症状的人,很难确定症状的急性恶化。
UNASSIGNED: Aspirin-exacerbated respiratory disease (AERD) is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes.
UNASSIGNED: To characterize the most common timeline for development of the clinical triad [asthma, nasal polyposis, and reactions to nonsteroidal anti-inflammatory drugs (NSAIDs)], identify barriers to prompt diagnosis of AERD, and describe indications for an aspirin challenge to facilitate accurate diagnosis.
UNASSIGNED: Six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women\'s Hospital AERD registry. Patient reported age at disease onset of asthma, nasal polyposis, and age of first NSAID reaction were obtained from 2013 to 2019 at enrollment.
UNASSIGNED: Of the 697 patients identified, diagnosis of asthma preceded diagnosis of nasal polyposis and first NSAID reaction, although there was considerable variability between patients.
UNASSIGNED: Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients. Consider diagnostic aspirin challenge in patients without historical reactions to NSAIDs who have an otherwise compatible clinical history, specifically in patients who take daily low-dose aspirin, leukotriene modifiers, avoid NSAIDs, or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.