Chronic hyperplastic eosinophilic sinusitis as a predictor of aspirin-exacerbated respiratory disease.
BACKGROUND
Aspirin-exacerbated respiratory disease (AERD) is a disease of intense eosinophilic inflammation that can produce fibrosis, hyperplasia, and remodeling.


OBJECTIVE
To investigate the usefulness of quantifying severity of chronic hyperplastic eosinophilic sinusitis in predicting the presence of AERD.


METHODS
Data were compared between asthmatic patients who reported exacerbations after aspirin ingestion and those who did not. The primary outcome measure was severity of sinusitis using a validated computed tomography (CT) scan-based scoring system. Indices of lower airway remodeling and other markers of inflammation were also evaluated.


RESULTS
Twenty-one patients with AERD were compared with 19 patients with aspirin-tolerant asthma (ATA). Patients were well matched for asthma severity as shown by their similar lung function as measured by postbronchodilator forced expiratory volume in 1 second. Patients with AERD were distinguished by their sinus CT scores (AERD patients: 16.9; 95% confidence interval [CI], 13.4-21.3; ATA patients: 6.2; 95% CI, 4.2-9.1; P < .001), and they were considerably more likely to have nasal polyps (AERD patients: 90%; ATA patients: 26%; P < .001). In addition, AERD patients demonstrated increased total lung capacity (AERD patients: 107.9%; 95% CI, 99.9%-117.6%; ATA patients: 98.0%; 95% CI, 93.7%-102.5%; P = .05), reflecting a trend toward increased air trapping. No significant differences occurred in diffusing capacity, exhaled nitric oxide, eosinophilia, or exhaled breath condensate pH.


CONCLUSIONS
AERD can be distinguished from ATA by the extent of hyperplasia on CT scan and the presence of nasal polyps. We hypothesize that AERD represents a remodeling process that affects both the upper and lower airways.
Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia 22908-1355, USA.
Kimberly
K
Mascia
Larry
L
Borish
James
J
Patrie
John
J
Hunt
C Douglas
CD
Phillips
John W
JW
Steinke
D000328:Adult; D001241:Aspirin / Q000009:adverse effects*; D001249:Asthma / Q000175:diagnosis / Q000276:immunology; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis*; D004802:Eosinophilia / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000175:diagnosis*; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000276:immunology; D014057:Tomography, X-Ray Computed
D001241:Aspirin