NSAID-exacerbated respiratory disease: a population study

Heidi Andersén; Pinja Ilmarinen; Jasmin Honkamäki; Leena E Tuomisto; Hanna Hisinger-Mölkänen; Helena Backman; Bo Lundbäck; Eva Rönmark; Tari Haahtela; Anssi Sovijärvi; Lauri Lehtimäki; Päivi Piirilä; Hannu Kankaanranta

doi:10.1183/23120541.00462-2021

NSAID-exacerbated respiratory disease: a population study

ERJ Open Res. 2022 Jan 24;8(1):00462-2021. doi: 10.1183/23120541.00462-2021. eCollection 2022 Jan.

Authors

Heidi Andersén^{1

2

3}, Pinja Ilmarinen^{1

4}, Jasmin Honkamäki¹, Leena E Tuomisto⁴, Hanna Hisinger-Mölkänen⁵, Helena Backman⁶, Bo Lundbäck⁷, Eva Rönmark⁶, Tari Haahtela⁵, Anssi Sovijärvi^{5

8}, Lauri Lehtimäki^{1

9}, Päivi Piirilä^{5

8}, Hannu Kankaanranta^{1

4

7}

Affiliations

¹ Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland.
² Thoracic Oncology Unit, Karolinska University Hospital, Tema Cancer, Stockholm, Sweden.
³ Oncology Unit, Vaasa Keskussairaala, Vaasa, Finland.
⁴ Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
⁵ Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁶ Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
⁷ Dept of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Unit of Clinical Physiology, Dept of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
⁹ Allergy Centre, Tampere University Hospital, Tampere, Finland.

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent European Academy of Allergy and Clinical Immunology position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD.

Methods: In 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20-69 years was performed in Helsinki and Western Finland. The response rate was 51.5%.

Results: The prevalence was 1.4% for N-ERD, and 0.7% for aspirin-exacerbated respiratory disease (AERD). The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis. The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The subphenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the fewest symptoms.

Conclusion: We conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity.