Factors affecting upper airway control of NSAID-exacerbated respiratory disease: A real-world study of 167 patients

Annina Lyly, Anu Laulajainen-Hongisto, Heikki Turpeinen, Seija I. Vento, Jyri Myller, Jura Numminen, Saara Sillanpää, Johanna Sahlman, Paula Kauppi, Sanna Toppila-Salmi

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Background: Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) is a triad with asthma, chronic rhinosinusitis with nasal polyps, and NSAID intolerance. Uncontrolled N-ERD forms a major public health problem due to frequent and difficult-to-treat exacerbations and/or requiring putatively frequent endoscopic sinus surgeries (ESS). Our aim was to study factors affecting control of N-ERD. Methods: Retrospective patient record data (patient characteristics, prior sinus surgeries, follow-up data in 2020) from 167 N-ERD patients undergoing consultation at three tertiary hospitals from 2001 to 2017 was used. Outcome measurements reflecting uncontrolled N-ERD were revision ESS, corticosteroids/biological therapy, and antibiotic courses during 2016–2020. Associations were analyzed by using nonparametric tests, Cox's proportional hazard, and binary logistic regression models. Results: Nasal polyp eosinophilia increased the risk of revision surgery during the follow-up (adjusted hazard ratio [aHR] 3.21, confidence interval 1.23–8.38). Also baseline oral corticosteroids (OCS; HR, 1.73, 1.04–2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07–4.42) in unadjusted models. In addition, both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23–6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98–4.70) were associated with the use of OCS/biological therapy during the follow-up, but not with high number of antibiotics. Conclusions: Nasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N-ERD. These factors might be clinically useful in risk-estimation of uncontrolled disease and for organizing follow-ups. Prospective cohort studies with larger sample size are needed to further study the factors affecting the upper airway control of N-ERD.

Original languageEnglish
Pages (from-to)80-89
JournalImmunity, Inflammation And Disease
Issue number1
Publication statusPublished - 2021
Publication typeA1 Journal article-refereed


  • asthma
  • CRS
  • disease control
  • eosinophilia
  • N-ERD
  • nasal polyps

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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