Long-term clinical effects of aspirin-desensitization therapy among patients with poorly controlled asthma and non-steroidal anti-inflammatory drug hypersensitivity: An exploratory study
a Department of Otorhinolaryngology, Campus Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
b Department of Otorhinolaryngology, Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 13353 Berlin, Germany
c Department of Allergy and Pulmonology, Johanniterstrasse 1, 14929 Treuenbrietzen, Germany
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Förster-Ruhrmann, S.-M. Zappe, A.J. Szczepek, H. Olze, U. Rabe" "autores" => array:5 [ 0 => array:4 [ "Iniciales" => "U." "apellidos" => "Förster-Ruhrmann" "email" => array:1 [ 0 => "ulrike.foerster@charite.de" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "S.-M." "apellidos" => "Zappe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "A.J." "apellidos" => "Szczepek" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "H." "apellidos" => "Olze" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "U." "apellidos" => "Rabe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Otorhinolaryngology, Campus Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Otorhinolaryngology, Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 13353 Berlin, Germany" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Department of Allergy and Pulmonology, Johanniterstrasse 1, 14929 Treuenbrietzen, Germany" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. ulrike.foerster@charite.de" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445969fig1.jpg" "Alto" => 2366 "Ancho" => 2649 "Tamanyo" => 695998 ] ] "descripcion" => array:1 [ "en" => "Pulmonary function values before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Vital capacity (VC) values; (b) forced expiratory volume in 1 s (FEV1) values; (c) asthma control levels (1: uncontrolled; 2: partial controlled; 3: controlled) and (d) FEV1 values of prednisolone dependent patients)." ] ] ] "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Asthma is a global respiratory health problem affecting 1-18% of the population in different countries.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> According to the Global Initiative for Asthma (GINA), the levels of asthma symptom control can be divided into controlled, partially controlled and uncontrolled asthma forms.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) can be detected among 13–21% of the asthmatics.<a href="#bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">, </span><a href="#bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> For the asthmatics with nasal polyps (NP), the incidence of NSAIDs intolerance increases to 30%.<a href="#bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> This association has been termed as “aspirin triad”, “aspirin-exacerbated respiratory disease” (AERD) or “NSAIDs hypersensitivity”.<a href="#bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">, </span><a href="#bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> The pathogenesis of the AERD is based on a shift from eicosanoids to leukotrienes.<a href="#bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> Depending in its severity, asthma can be treated with beta-2 mimetics, corticosteroids, leukotriene receptor antagonists, theophylline or anti-IgE antibodies.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> A further therapeutic option for asthmatics and NSAIDs hypersensitivity is the aspirin desensitization,<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> where the patient is gradually introduced step by step to aspirin, and a daily maintenance dose is determined. The underlying mechanism of aspirin desensitization has until today not yet been completely clarified. Interestingly, following desensitization, there is an increase in the prostaglandin PGE<span class="elsevierStyleInf">2</span>/leukotriene index in patients’ blood.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> To the best of our knowledge, clinical effects of aspirin desensitization in patients with a poorly controlled asthma and NSAIDs hypersensitivity have not yet been reported. For this reason, the aim of our study was to investigate the outcome of aspirin desensitization in patients with NSAIDs hypersensitivity and a poorly controlled asthma. We performed comparative analyses using the data obtained from the patients with controlled asthma and NSAIDs hypersensitivity who underwent aspirin therapy.</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStylePara">Patients routinely desensitized against at least 18 months in the Department of Pulmonology (Treuenbrietzen, Germany) or the ORL Department of the Charité University Hospital (Berlin) between 2009 and 2013 were included in this retrospective study. All patients enrolled in the study gave their informed consent. The inclusion criteria were NSAIDs sensitivity, nasal polyps, controlled or poorly controlled asthma.</p><p class="elsevierStylePara">Twelve patients (mean age 48 y, range from 32 y to 73 y, 4 men, 8 women) with poorly controlled asthma and 20 patients with controlled asthma (mean age 57.75 y, range from 44 y to 67 y, 8 men, 12 women) were included. The “poorly controlled asthma”-group consisted of ten patients with uncontrolled asthma and two patients with partially controlled asthma. Aspirin was recommended to be taken by both groups, in order to improve the nasal and asthma symptoms.</p><p class="elsevierStylePara">NSAIDs sensitivity was confirmed by oral aspirin provocation test; a positive reaction was a decline of forced expiratory volume in 1 s (FEV1) ≥ 20% of baseline and profound rhinorrhea or nasal blockage.<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> The patients were stepwise desensitized to oral aspirin in the hospital with a final daily aspirin maintenance dosage of 500 mg. The following desensitization protocol was used: day 1: placebo/placebo/placebo; day 2: 1/2/4/8; day 3: 10/20/40/80; day 4: 100/100/150; day 5: 200/200/500; from day 6: 500 mg orally administered aspirin.</p><p class="elsevierStylePara">Following parameters were evaluated:</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Levels of asthma symptom control</span>: Assessment of symptom control was done by strictly following the GINA criteria<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> – see <a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>. Following groups of patients were identified:</p><ul><li><p class="elsevierStylePara">1. Controlled or stable asthma group: well controlled asthma;</p></li><li><p class="elsevierStylePara">2. Poorly controlled or instable asthma group: partially controlled asthma/uncontrolled asthma.</p></li></ul><p class="elsevierStylePara">Table 1. GINA assessment of asthma symptom control.</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td colspan="3">Asthma symptom control</td><td colspan="3">Levels of asthma symptom control</td></tr><tr align="left"><td colspan="3">In the past 4 weeks, has the patient had</td><td>Well controlled</td><td>Partially controlled</td><td>Uncontrolled</td></tr><tr align="left"><td>Day time asthma<br></br>Symptoms more than twice/week</td><td>Yes□</td><td>No□</td><td rowspan="4">None of these</td><td rowspan="4">1–2 of these</td><td rowspan="4">3–4 of these</td></tr><tr align="left"><td>Any night waking due to asthma?</td><td>Yes□</td><td>No□</td></tr><tr align="left"><td>Reliever needed for symptoms more than twice/week</td><td>Yes□</td><td>No□</td></tr><tr align="left"><td>Any activity limitation due to asthma?</td><td>Yes□</td><td>No□</td></tr></table><p class="elsevierStylePara"><span class="elsevierStyleBold">Pulmonary function values</span>: The peak expiratory flow (PEF) variability was measured before aspirin desensitization. The forced expiratory volume in 1 s (FEV1) and vital capacity (VC) were measured by spirometry before and following aspirin treatment.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Use of asthma medication</span>: The daily use and dosages of the asthma medication were documented. The daily dosages of inhaled corticoids (ICS low/medium/high dosage) and the asthma medication scores were obtained in accordance to GINA criteria.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Prednisolone-dependent patients were separated from the dual GINA classification of severity. The medication was not changed 6 months prior to desensitization.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Nasal endoscopy</span>: The Davos-staging of nasal polyps (NP) size was performed (0: no NP; 1: NP in middle meatus; 2: NP beyond middle meatus; 3: obstructing NP).<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Sense of smell</span>: The subjective olfactory function was semi-quantitatively documented (0: no sense of smell; 1: mild sense of smell; 2: moderate sense of smell; 3: excellent sense of smell).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Follow-up</span>: The patients were routinely examined before aspirin therapy, 6, 12 and 18 months (visit 1, 2 and 3) following aspirin therapy. Pulmonary and nasal parameters were documented.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Adverse events</span>: Adverse events during aspirin induction and maintenance therapy were documented.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistics</span>: A nonparametric test of independent samples (Mann–Whitney <span class="elsevierStyleItalic">U</span> test) was used to test the spirometric parameters FEV-1 and VC, asthma medication and the nasal polyps between patient groups. The levels of asthma control and smell were tested with the chi-squared test (<span class="elsevierStyleItalic">p</span> < 0.05).</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Patients’ characterization prior to aspirin desensitization therapy</span><p class="elsevierStylePara">The mean FEV1-, VC values were significantly lower and PEF variability values higher in the poorly controlled asthma patients (<span class="elsevierStyleItalic">p</span> < 0.01). The nasal polyps size did not differ significantly (0.55/0.95; <span class="elsevierStyleItalic">p</span> = 0.21). The asthma medication score in poorly controlled asthma patients was significantly higher than in the controlled group (4.25/2.20, <span class="elsevierStyleItalic">p</span> < 0.01).</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Patients with poorly controlled asthma following aspirin desensitization therapy</span><p class="elsevierStylePara">In relation to the symptoms of the asthma control levels four patients (33.3%) still had uncontrolled asthma and eight patients controlled asthma after 6 months (67%). After 12 months of aspirin therapy 11 patients had controlled asthma (91.7%) and one patient with uncontrolled asthma, which finally improved to partially controlled asthma after 18 months. The asthma control level of all visits following aspirin therapy improved significantly when compared to the baseline, <span class="elsevierStyleItalic">p</span> < 0.01. The mean FEV1 values increased from the initial 67.4% to 82.4% after 12 months (<span class="elsevierStyleItalic">p</span> 0.03). The VC values increased from the initial 83.9% to 87.8% (<span class="elsevierStyleItalic">p</span> 1.00), the size of nasal polyps from initial 0.33 to 0.50 (<span class="elsevierStyleItalic">p</span> 0.56). The sense of smell improved significantly after 18 months from 1.85 to 2.25 (<span class="elsevierStyleItalic">p</span> 0.02) (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>, <a href="#f0010" class="elsevierStyleCrossRefs">Figure 2</a>). The asthma medication score declined from 4.2 to 3.9 (<span class="elsevierStyleItalic">p</span> < 0.18).</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n06-90445969fig1.jpg" alt="Pulmonary function values before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Vital capacity (VC) values; (b) forced expiratory volume in 1 s (FEV1) values; (c) asthma control levels (1: uncontrolled; 2: partial controlled; 3: controlled) and (d) FEV1 values of prednisolone dependent patients)."></img></p><p class="elsevierStylePara">Figure 1. Pulmonary function values before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Vital capacity (VC) values; (b) forced expiratory volume in 1 s (FEV1) values; (c) asthma control levels (1: uncontrolled; 2: partial controlled; 3: controlled) and (d) FEV1 values of prednisolone dependent patients).</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n06-90445969fig2.jpg" alt="Nasal parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Nasal polyps and (b) smell ability)."></img></p><p class="elsevierStylePara">Figure 2. Nasal parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Nasal polyps and (b) smell ability).</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Patients with controlled asthma following aspirin desensitization therapy</span><p class="elsevierStylePara">No patient developed uncontrolled asthma during the follow-up examination. The mean FEV values were 92% before and 92.4% following therapy, the VC values 101.6% before and 96.3% following aspirin desensitization (<span class="elsevierStyleItalic">p</span> ≥ 0.50). The nasal polyps scores decreased (0.95/0.65; <span class="elsevierStyleItalic">p</span> 1.00). The sense of smell improved from 1.50 to 2.15 (<span class="elsevierStyleItalic">p</span> 0.16), the sense of smell scores improved significantly after 12 months (<span class="elsevierStyleItalic">p</span> = 0.03) (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>, <a href="#f0010" class="elsevierStyleCrossRefs">Figure 2</a>). The asthma medication level in this group was constant 2.2 (<span class="elsevierStyleItalic">p</span> = 1.00).</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Comparison of the poorly controlled and the controlled asthma patients following 18 months of aspirin therapy</span><p class="elsevierStylePara">After 18 months, the FEV1 values and the size of nasal polyps did not differ significantly between the patient groups, the VC values from the poorly controlled asthma group were significantly lower (84.4%/93.5%; <span class="elsevierStyleItalic">p</span> 0.03). In addition, the medication score was still significantly elevated in the poorly controlled asthma group (<span class="elsevierStyleItalic">p</span> < 0.01).</p><a name="sec0070" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Examination of corticosteroid-dependent patients</span><a name="sec0075" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Patient group with controlled asthma and oral prednisolone</span></span><p class="elsevierStylePara">One patient was on permanent oral 10 mg prednisolone. The mean FEV1 value decreased from initial 72% to 69%, the nasal polyp size increased from 0 to 2 after 18 months aspirin therapy.</p><a name="sec0080" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Patient group with uncontrolled asthma and oral prednisolone</span></span><p class="elsevierStylePara">Prior to desensitization, four patients were on permanent oral prednisolone (mean dosage 13.3 mg). After 18 months therapy one patient had partial controlled asthma and the other patients had controlled asthma. The mean prednisolone dosage was reduced to 6.5 mg (<a href="#f0015" class="elsevierStyleCrossRefs">Figure 3</a>). The mean FEV1 value increased from 60% to 97% and the nasal polyp size from 0 to 0.67.</p><a name="f0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n06-90445969fig3.jpg" alt="Asthma medication parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) asthma medication of stable asthma patients; (b) asthma medication of instable asthma patients and (c) corticoiddosages of asthma patients)."></img></p><p class="elsevierStylePara">Figure 3. Asthma medication parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) asthma medication of stable asthma patients; (b) asthma medication of instable asthma patients and (c) corticoiddosages of asthma patients).</p><a name="sec0085" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Patient group with uncontrolled asthma and intravenous prednisolone</span></span><p class="elsevierStylePara">One patient had an asthma exacerbation before aspirin therapy and was treated with an intravenous prednisolone pulse therapy (initial dosage 250 mg). The FEV1 was 46% and the nasal polyp size 0. After 18 months of aspirin desensitization, the asthma was controlled, FEV1 was 89% and the nasal polyp size 0. Parenteral prednisolone therapies were not repeated.</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Adverse events</span><p class="elsevierStylePara">In three patients with poorly controlled asthma, administration of aspirin induced recurrent asthma attacks. These patients were initially administered 150 mg or 300 mg aspirin. During the second desensitization appointment, the dosage of aspirin has been increased to 500 mg, which induced no complications. During the maintenance therapy, no adverse events were observed.</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">This retrospective study demonstrates for the first time that the patients with a NSAIDs-hypersensitivity and poorly controlled asthma can benefit from aspirin desensitization. Following 6 months desensitization, the asthma control levels significant improved. In epidemiological studies, the asthma severity in NDAIDs hypersensitive patients was higher and FEV1 values lower, as compared to NSAIDs tolerant asthma patients.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">, </span><a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> In both studies, aspirin therapy was not performed. The pathomechanism of the NSAIDs hypersensitivity is based on an altered cyclooxygenase metabolism.<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> The effect of aspirin desensitization is not yet really clear. Under the daily aspirin administration, a significant increase of the prostaglandin E<span class="elsevierStyleInf">2</span>/leukotriene index<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> appears to take place.</p><p class="elsevierStylePara">According to GINA criteria, the main goal of asthma management is to gain optimal asthma control.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Depending on the severity of the disease, a multimodal therapy involving beta-2-mimetics, corticosteroids, leukotriene receptor antagonists, and theophylline or anti-IgE antibodies is necessary. Dahlén et al. examined the effects of leukotriene receptor antagonist montelukast in NSAIDs-hypersensitive patients and found significantly improved FEV1 values.<a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a> Some patients in our study were treated with montelukast (see <a href="#f0015" class="elsevierStyleCrossRefs">Figure 3</a>). Since no changes in medication were made, our results appear to be aspirin-dependent.</p><p class="elsevierStylePara">Berges Gimeno examined 126 patients (daily 1300 mg aspirin) and registered over one year a significant reduction of nasal symptoms and a significant reduction in the number of short-term prednisolone treatments due to asthma.<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> In our study the oral prednisolone dosage was reduced from the original mean 13.3 mg to mean 6.5 mg in instable asthma patients. One instable asthma patient who received intravenous prednisolone during asthma exacerbation prior to aspirin desensitization, no longer needed corticosteroids after desensitization. In the work of Stevenson, inclusion criteria for the aspirin desensitization required a FEV1 variability of <10% and FEV1 values of >60%.<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a> In our study, we included patients with PEF variability greater than 10% (instable asthma 45%; stable asthma 14%). The mean FEV1 values in our sample were better than Stevensons’ inclusion criteria (instable asthma 67%; stable asthma 92%). We demonstrated that the FEV1 values significantly improved in the poorly controlled asthma patients following 12 months of aspirin therapy (<span class="elsevierStyleItalic">p</span> 0.03). Also, the FEV1 values of corticosteroid-dependent patients increased following aspirin therapy in our study (<a href="#f0015" class="elsevierStyleCrossRefs">Figure 3</a>).</p><p class="elsevierStylePara">Havel et al. found that 56 patients with NSAIDs hypersensitivity receiving aspirin for more than 18 months (daily 500 mg aspirin) following nasal sinus surgery have improved in relation to asthma and nasal complaints.<a href="#bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a> The spirometric examinations were not done in follow-up. A significantly lower nasal polyp size in patients receiving aspirin was observed, as compared to the patients not receiving aspirin. In our study, the difference in nasal polyp size before and after aspirin therapy was not significant, which may depend on our inclusion criteria, where we did not compare nasal polyp groups with and without aspirin desensitization therapy and our patients were not all included immediately after surgery.</p><p class="elsevierStylePara">Therapy of patients with therapy-resistant asthma and NSAIDs hypersensitivity requires a multimodal therapeutic concept according to pulmonary guidelines. To the best of our knowledge, the present study is the first retrospective examination of patients with NSAIDs hypersensitivity and poorly controlled asthma receiving aspirin therapy. Concerning the asthma symptom control levels, a significant improvement was observed (<span class="elsevierStyleItalic">p</span> < 0.01). Although the patients certainly profit from the asthma medication administered according to GINA guidelines, they can also profit from an add-on aspirin therapy. Further studies with larger samples are necessary to further validate this therapy. This exploratory retrospective analysis will be continued in order to compare NSAIDs sensitive asthmatic patients subjected to NSAIDs desensitization with the patients receiving standard therapy.</p><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0090" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study.</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p><a name="sec0095" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article.</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Author contribution</span><p class="elsevierStylePara">UFR: conceived the study, performed patients examinations, collected and interpreted the data and wrote the manuscript.</p><p class="elsevierStylePara">SM.Z: performed patients examinations and collected the data.</p><p class="elsevierStylePara">AJ.S: interpreted the data and wrote the manuscript.</p><p class="elsevierStylePara">HO: supervised the project, interpreted the data and wrote the manuscript.</p><p class="elsevierStylePara">UR: conceived the study, performed patients examinations, supervised the project and wrote the manuscript.</p><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Received 24 September 2014 <br></br>Accepted 5 June 2015 </p><p class="elsevierStylePara">Corresponding author. ulrike.foerster@charite.de</p>" "pdfFichero" => "320v21n06a90445969pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec640964" "palabras" => array:8 [ 0 => "Asthma" 1 => "Levels of asthma symptom control" 2 => "GINA" 3 => "Uncontrolled asthma" 4 => "Aspirin-exacerbated respiratory disease (AERD)" 5 => "NSAIDs hypersensitivity" 6 => "NSAIDs sensitive asthma" 7 => "Nasal polyps" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><br/><p class="elsevierStylePara">According to the Global Initiative for Asthma (GINA), the levels of asthma symptom control can be divided into controlled, partially controlled and uncontrolled asthma. Optional therapy for non-steroidal anti-inflammatory drugs (NSAIDs)-hypersensitive asthmatics uses aspirin desensitization, but until now, this therapy is not established in difficult to treat cases. The aim of this study was to evaluate the efficacy of aspirin desensitization in patients with poorly controlled asthma.</p><span class="elsevierStyleSectionTitle">Methods</span><br/><p class="elsevierStylePara">Patients with poorly controlled asthma, NDAIDs hypersensitivity and aspirin desensitization were included in the retrospective study. The data were compared to those obtained from patients with controlled asthma and aspirin therapy. Lung function, levels of asthma symptom control, asthma medication, the size of nasal polyps (NP) and smell function were evaluated over 18 months.</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">Thirty-two patients were included in the study (uncontrolled/partially controlled asthma <span class="elsevierStyleItalic">n</span> = 12; controlled asthma <span class="elsevierStyleItalic">n</span> = 20). After 18 months of follow-up, the patients with poorly controlled asthma had significantly increased forced expiratory volume in 1 s (FEV1) values, as compared to the baseline (66–82%; <span class="elsevierStyleItalic">p</span> = 0.02), the levels of asthma control improved significantly (<span class="elsevierStyleItalic">p</span> < 0.01). The asthma medication was reduced. In the group of controlled asthma the FEV1 values did not increase significantly (91.9–92.4%; <span class="elsevierStyleItalic">p</span> > 0.05) and the asthma medication was constant. In relation to nasal parameters the sense of smell improved significantly in both groups, NP-scores did not differ significantly.</p><span class="elsevierStyleSectionTitle">Conclusions</span><br/><p class="elsevierStylePara">Patients with a poorly controlled asthma and NSAIDs hypersensitivity profit from an add-on aspirin therapy.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445969fig1.jpg" "Alto" => 2366 "Ancho" => 2649 "Tamanyo" => 695998 ] ] "descripcion" => array:1 [ "en" => "Pulmonary function values before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Vital capacity (VC) values; (b) forced expiratory volume in 1 s (FEV1) values; (c) asthma control levels (1: uncontrolled; 2: partial controlled; 3: controlled) and (d) FEV1 values of prednisolone dependent patients)." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445969fig2.jpg" "Alto" => 1148 "Ancho" => 2441 "Tamanyo" => 258824 ] ] "descripcion" => array:1 [ "en" => "Nasal parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Nasal polyps and (b) smell ability)." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445969fig3.jpg" "Alto" => 2295 "Ancho" => 3210 "Tamanyo" => 819577 ] ] "descripcion" => array:1 [ "en" => "Asthma medication parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) asthma medication of stable asthma patients; (b) asthma medication of instable asthma patients and (c) corticoiddosages of asthma patients)." ] ] 3 => array:6 [ "identificador" => "fig4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Pulmonary function values before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Vital capacity (VC) values; (b) forced expiratory volume in 1 s (FEV1) values; (c) asthma control levels (1: uncontrolled; 2: partial controlled; 3: controlled) and (d) FEV1 values of prednisolone dependent patients)." ] ] 4 => array:6 [ "identificador" => "fig5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Nasal parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) Nasal polyps and (b) smell ability)." ] ] 5 => array:6 [ "identificador" => "fig6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Asthma medication parameters before and after acetylsalicylic acid (ASA) desensitization therapy ((a) asthma medication of stable asthma patients; (b) asthma medication of instable asthma patients and (c) corticoiddosages of asthma patients)." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Global Initiative for Asthma (GINA). 2014. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 7 | 16 |
| 2024 October | 46 | 32 | 78 |
| 2024 September | 54 | 19 | 73 |
| 2024 August | 57 | 26 | 83 |
| 2024 July | 72 | 37 | 109 |
| 2024 June | 42 | 29 | 71 |
| 2024 May | 66 | 40 | 106 |
| 2024 April | 52 | 28 | 80 |
| 2024 March | 51 | 25 | 76 |
| 2024 February | 45 | 20 | 65 |
| 2024 January | 28 | 22 | 50 |
| 2023 December | 29 | 29 | 58 |
| 2023 November | 34 | 35 | 69 |
| 2023 October | 29 | 34 | 63 |
| 2023 September | 25 | 34 | 59 |
| 2023 August | 28 | 23 | 51 |
| 2023 July | 31 | 30 | 61 |
| 2023 June | 39 | 22 | 61 |
| 2023 May | 50 | 19 | 69 |
| 2023 April | 52 | 17 | 69 |
| 2023 March | 112 | 21 | 133 |
| 2023 February | 62 | 20 | 82 |
| 2023 January | 30 | 19 | 49 |
| 2022 December | 81 | 17 | 98 |
| 2022 November | 68 | 36 | 104 |
| 2022 October | 70 | 39 | 109 |
| 2022 September | 28 | 27 | 55 |
| 2022 August | 51 | 54 | 105 |
| 2022 July | 43 | 46 | 89 |
| 2022 June | 26 | 29 | 55 |
| 2022 May | 37 | 51 | 88 |
| 2022 April | 34 | 35 | 69 |
| 2022 March | 31 | 50 | 81 |
| 2022 February | 37 | 34 | 71 |
| 2022 January | 27 | 35 | 62 |
| 2021 December | 23 | 39 | 62 |
| 2021 November | 33 | 35 | 68 |
| 2021 October | 34 | 49 | 83 |
| 2021 September | 25 | 33 | 58 |
| 2021 August | 31 | 20 | 51 |
| 2021 July | 23 | 23 | 46 |
| 2021 June | 35 | 34 | 69 |
| 2021 May | 41 | 35 | 76 |
| 2021 April | 120 | 66 | 186 |
| 2021 March | 106 | 27 | 133 |
| 2021 February | 75 | 22 | 97 |
| 2021 January | 54 | 20 | 74 |
| 2020 December | 46 | 6 | 52 |
| 2020 November | 54 | 14 | 68 |
| 2020 October | 65 | 16 | 81 |
| 2020 September | 80 | 20 | 100 |
| 2020 August | 79 | 30 | 109 |
| 2020 July | 105 | 19 | 124 |
| 2020 June | 86 | 24 | 110 |
| 2020 May | 99 | 19 | 118 |
| 2020 April | 131 | 9 | 140 |
| 2020 March | 87 | 18 | 105 |
| 2020 February | 105 | 23 | 128 |
| 2020 January | 95 | 19 | 114 |
| 2019 December | 78 | 18 | 96 |
| 2019 November | 93 | 23 | 116 |
| 2019 October | 87 | 21 | 108 |
| 2019 September | 79 | 20 | 99 |
| 2019 August | 148 | 14 | 162 |
| 2019 July | 141 | 16 | 157 |
| 2019 June | 170 | 10 | 180 |
| 2019 May | 127 | 10 | 137 |
| 2019 April | 154 | 25 | 179 |
| 2019 March | 182 | 16 | 198 |
| 2019 February | 160 | 7 | 167 |
| 2019 January | 165 | 24 | 189 |
| 2018 December | 94 | 9 | 103 |
| 2018 November | 47 | 2 | 49 |
| 2018 October | 57 | 9 | 66 |
| 2018 September | 25 | 4 | 29 |
| 2018 August | 32 | 20 | 52 |
| 2018 July | 25 | 15 | 40 |
| 2018 June | 23 | 20 | 43 |
| 2018 May | 18 | 14 | 32 |
| 2018 April | 41 | 16 | 57 |
| 2018 March | 49 | 20 | 69 |
| 2018 February | 17 | 12 | 29 |
| 2018 January | 20 | 14 | 34 |
| 2017 December | 30 | 20 | 50 |
| 2017 November | 23 | 12 | 35 |
| 2017 October | 24 | 16 | 40 |
| 2017 September | 19 | 19 | 38 |
| 2017 August | 28 | 17 | 45 |
| 2017 July | 15 | 14 | 29 |
| 2017 June | 18 | 12 | 30 |
| 2017 May | 22 | 27 | 49 |
| 2017 April | 12 | 11 | 23 |
| 2017 March | 13 | 10 | 23 |
| 2017 February | 4 | 7 | 11 |
| 2017 January | 14 | 8 | 22 |
| 2016 December | 16 | 18 | 34 |
| 2016 November | 22 | 13 | 35 |
| 2016 October | 24 | 19 | 43 |
| 2016 September | 20 | 12 | 32 |
| 2016 August | 20 | 17 | 37 |
| 2016 July | 25 | 48 | 73 |
| 2016 June | 0 | 52 | 52 |
| 2016 May | 3 | 7 | 10 |
| 2016 April | 24 | 21 | 45 |
| 2016 March | 31 | 17 | 48 |
| 2016 February | 34 | 32 | 66 |
| 2016 January | 77 | 54 | 131 |
| 2015 December | 76 | 70 | 146 |
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