Predicting outcomes of oral aspirin challenges in patients with asthma, nasal polyps, and chronic sinusitis
Predicting outcomes of oral aspirin challenges in patients with asthma, nasal polyps, and chronic sinusitis
复制标题
DOI：
10.1016/s1081-1206(10)60465-6
复制
发表时间：
2008-05-01
影响因子：
5.9
通讯作者：
Stevenson, Donald D.
中科院分区：
文献类型：
--
作者：
Dursun, Adile Berna;Woessner, Katharine A.;Stevenson, Donald D.
背景资料：阿司匹林急性呼吸道疾病（AERD）的确诊需要口服阿司匹林激发试验（OAC）阳性，但预测哪些患者会有阳性激发试验往往是困难的。目的：分析阿司匹林和非甾体抗炎药（NSAID）相关呼吸道反应的历史信息和临床特征，作为预测阳性OAC的潜在标志物。共有243例患者接受了OAC。与以前的反应和患者的临床特征相关的数据与OACs.Results的结果：没有事先暴露于阿司匹林或NSAID，一个积极的OAC的机会是5在12（42%），但在231（86%）的阿司匹林和NSAID相关的哮喘发作的历史为198。性别、特应性、每年鼻窦感染次数和鼻窦手术次数与阳性OAC无关。既往有2次或2次以上阿司匹林和NSAID相关呼吸反应的患者与单次反应者相比，OAC阳性的几率为89%（80%; P = 0.04）。轻度或中度既往反应与84%或80%阳性OAC相关，而45例重度既往反应患者中100%的OAC阳性（P = 0.007）。除住院治疗外，既往反应的治疗地点（家庭或急诊室）似乎没有任何差异。Logistic回归确定年龄，嗅觉，和多个先前的反应作为独立的危险因素与积极OACs.Conclusions：年龄小于40岁，嗅觉差，多个先前的呼吸道反应，严重的哮喘反应与阿司匹林和NSAID显着增加的机会，积极OAC。
Background: A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult.Objective: To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs.Methods: A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs.Results: Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs.Conclusions: Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.