Influence of daily aspirin therapy on ACE2 expression and function – implications for SARS‐CoV2 and patients with aspirin‐exacerbated respiratory disease

Background Aspirin-exacerbated respiratory disease (AERD) is a disorder of nasal polyposis, asthma, and hypersensitivity respiratory reactions when on systemic cyclooxygenase 1 blockade. Methods AERD Warrants Specific Evaluation As An Endotype Of Asthma And Chronic Sinus Disease Due To Unique Therapeutic Opportunities. Currently, Aspirin Therapy Is Uniquely Beneficial As An Anti-Inflammatory Therapy In Aerd, With Multiple Additional Therapies Currently In Early To Late Clinical Studies, Which Might Also Show Exceptional Benefit In AERD. Results Yet, given the lack of a simple diagnostic test, opportunities to identify patients with AERD are still frequently neglected. Conclusion Identifying the prevalence and population characteristics necessary to determine appropriate candidates in whom to perform diagnostic aspirin challenge remains critically important and was the purpose of this article.

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Effectiveness of endoscopic sinus surgery and aspirin therapy in the management of aspirin-exacerbated respiratory disease

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210002 ◽

2021 ◽

Vol 42 (2) ◽

pp. 136-141

Author(s):

Auddie M. Sweis ◽

Tran B. Locke ◽

Kevin I. Ig-Izevbekhai ◽

Theodore C. Lin ◽

Ankur Kumar ◽

...

Keyword(s):

Respiratory Disease ◽

Endoscopic Sinus Surgery ◽

Test Score ◽

Aspirin Therapy ◽

Sinus Surgery ◽

Secondary Outcome ◽

Persistent Symptoms ◽

Aspirin Exacerbated Respiratory Disease ◽

Patient Reported ◽

The Mean

Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.

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