Allergy Asthma Immunol Res.  2011 Oct;3(4):256-264. 10.4168/aair.2011.3.4.256.

Diagnostic Value of Clinical Parameters in the Prediction of Aspirin-Exacerbated Respiratory Disease in Asthma

• Chang HS
• Park JS
• Jang AS
• Park SW
• Uh ST
• Kim YH
• Park CS

• KMID: 2167077
• DOI: http://doi.org/10.4168/aair.2011.3.4.256

Abstract

PURPOSE
Aspirin-exacerbated respiratory disease (AERD) has attracted a great deal of attention because of its association with increased asthma severity. However, oral aspirin challenge (OAC) to diagnose AERD is a time-consuming procedure, and some patients experience serious complications. Thus, we evaluated diagnostic values of non-invasive clinical parameters to predict AERD in asthmatic patients.
METHODS
A total of 836 Korean subjects were recruited from an asthma cohort. They underwent OAC, and clinical parameters including the history of aspirin hypersensitivity, nasal polyposis, and chronic sinusitis of aspirin-tolerant asthma (ATA) and AERD asthmatic patients were compared.
RESULTS
Significant differences (P<0.01) were found in eight parameters: age at diagnosis, body mass index, FEV1%, PC20, history of urticaria, nasal polyps, chronic sinusitis, and history of aspirin hypersensitivity. After logistic regression analysis based on the eight clinical parameters, nasal polyps, history of aspirin intolerance, sinusitis, and log [PC20 methacholine] remained significantly associated with AERD (P<0.05). The sensitivity and specificity of the history of aspirin hypersensitivity to predict AERD were 64.7% and 92.0%, respectively, and the positive and negative predictive values were 56.9% and 94.1%, respectively. Overall, the accuracy of the test was 88.2%. The accuracy of the tests for nasal polyps and chronic sinusitis were 67.3% and 60.4%, respectively.
CONCLUSIONS
Among clinical parameters associated with AERD, the history of aspirin hypersensitivity has the best positive and negative predictive values for the oral aspirin challenge test. Because the false-positive and -negative rates were still high, additional non-invasive methods are needed to reduce the rate of false outcomes.

Keyword

Aspirin-exacerbated respiratory disease (AERD); aspirin hypersensitivity; history; nasal polyp; chronic sinusitis; oral aspirin challenge (OAC)

MeSH Terms

Aspirin
Asthma
Body Mass Index
Cohort Studies
Humans
Hypersensitivity
Logistic Models
Nasal Polyps
Sinusitis
Urticaria
Aspirin

Figure

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  Fig. 1 Receiver operating characteristic curve of relative risk scores and the area under the curve of parameters.

• 

  Fig. 2 The comparison of relative risk scores between aspirin-tolerant asthma (ATA) and aspirin-exacerbated respiratory disease (AERD). The relative risk scores were calculated using the following function: 0.874×nasal polyp+3.174×history of aspirin intolerance+1.453×sinusitis+(-0.918)×log [PC20 methacholine].

• 

  Fig. 3 Receiver operating characteristic curve for relative risk score.

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