title: Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease.
abstract: BACKGROUND
  Aspirin-exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 (COX-1) enzyme. The prevalence of AERD remains unclear, and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone, asthma alone, or both CRSwNP and asthma.
  
  
  OBJECTIVE
  To determine the prevalence of AERD within a tertiary care setting, and to identify unique clinical features that could distinguish these patients from those with both CRSwNP and asthma or with CRSwNP alone.
  
  
  METHODS
  Electronic medical records of patients at Northwestern in Chicago, Illinois, were searched by computer algorithm and then manual chart review to identify 459 patients with CRSwNP alone, 412 with both CRSwNP and asthma, 171 with AERD, and 300 with asthma only. Demographic and clinical features including sex, atopy, and sinus disease severity were characterized.
  
  
  RESULTS
  The prevalence of AERD among patients with CRSwNP was 16%. Patients with AERD had undergone 2-fold more sinus surgeries (P < .001) and were significantly younger at the time of their first surgery (40 ± 13 years) than were patients with CRSwNP (43 ± 14 years; P < .05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in patients with CRSwNP (66%, P < .05). More patients with AERD (13%) had corticosteroid-dependent disease than patients with both CRSwNP and asthma (4%, P < .01) or asthma (1%, P < .001).
  
  
  CONCLUSIONS
  AERD is common among patients with CRSwNP; even though patients with AERD have CRSwNP and asthma, the clinical course of their disease is not the same as of patients who have CRSwNP and asthma but are tolerant to COX-1 inhibitors.
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: whitney-stevens@northwestern.edu.
authors.forename: Whitney W
authors.initials: WW
authors.lastname: Stevens
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Anju T
authors.initials: AT
authors.lastname: Peters
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pa.
authors.forename: Annemarie G
authors.initials: AG
authors.lastname: Hirsch
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pa.
authors.forename: Cara M
authors.initials: CM
authors.lastname: Nordberg
authors.affiliation: Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pa.
authors.forename: Dione G
authors.initials: DG
authors.lastname: Mercer
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Mahboobeh
authors.initials: M
authors.lastname: Mahdavinia
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Grammer
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Hulse
authors.affiliation: Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Pedro
authors.initials: P
authors.lastname: Avila
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schleimer
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D055963:Asthma, Aspirin-Induced / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D015897:Comorbidity; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012129:Respiratory Function Tests; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
chemical_list: D016861:Cyclooxygenase Inhibitors; D001241:Aspirin
keywords: AERD; Asthma; CRS; CRSwNP; Samter's disease; Sinus