Is a positive nasal lysine-aspirin challenge test associated with a more severe phenotype of chronic rhinosinusitis and asthma?

Sriram Vaidyanathan, Peter A. Williamson, Brian J. Lipworth

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    Background: Current guidelines recommend a greater use of aspirin challenge testing in the diagnosis of aspirin-intolerant rhinosinusitis and asthma, a disorder with high burden of illness and resistance to treatment. The indications for these tests and their clinical significance remain unclear. This study was designed to characterize the phenotype of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma undergoing a nasal lysine-aspirin (L-ASA) challenge to evaluate which factors strongly predict a positive test.

    Methods: Seveny-five patients with CRSwNP underwent nasal challenge with 16 mg (total) of L-ASA after 30 minutes of acclimatization and diluent challenge. A positive challenge was defined as a 25% drop in total nasal volume measured by acoustic rhinometry.

    Results: Twenty-three (31%) participants gave a history of aspirin intolerance and 38 (51%) had a positive nasal L-ASA challenge. Upper airway measures (CT scan score, olfaction, polyp grading, peak nasal inspiratory flow, nasal symptoms, etc.) and lower airway measures (methacholine provocative concentration required to produce a 20% drop in forced expiratory volume in 1 second, effective special airway resistance, and spirometry) were not significantly worse in patients with a positive aspirin challenge. Test sensitivity was 48%, specificity was 52%, positive predictive value was 29%, and negative predictive value was 68%. A regression analysis identified forced expiratory flow at 25-75% (FEF25-75), history of aspirin intolerance, and duration of rhinosinusitis as significant predictors of a positive aspirin challenge.

    Conclusion: A positive response to nasal L-ASA challenge is not associated with a more severe phenotype of CRSwNP with or without asthma. A history of aspirin intolerance, duration of rhinosinusitis, and FEF25-75 predict a greater response to aspirin. (Am J Rhinol Allergy 26, e89-e93, 2012; doi: 10.2500/ajra.2012.26.3767)

    Original languageEnglish
    Pages (from-to)E89-E93
    Number of pages5
    JournalAmerican Journal of Rhinology & Allergy
    Volume26
    Issue number3
    Publication statusPublished - 2012

    Cite this

    @article{0252f7d8e034492a9d2b4500198401a6,
    title = "Is a positive nasal lysine-aspirin challenge test associated with a more severe phenotype of chronic rhinosinusitis and asthma?",
    abstract = "Background: Current guidelines recommend a greater use of aspirin challenge testing in the diagnosis of aspirin-intolerant rhinosinusitis and asthma, a disorder with high burden of illness and resistance to treatment. The indications for these tests and their clinical significance remain unclear. This study was designed to characterize the phenotype of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma undergoing a nasal lysine-aspirin (L-ASA) challenge to evaluate which factors strongly predict a positive test.Methods: Seveny-five patients with CRSwNP underwent nasal challenge with 16 mg (total) of L-ASA after 30 minutes of acclimatization and diluent challenge. A positive challenge was defined as a 25{\%} drop in total nasal volume measured by acoustic rhinometry.Results: Twenty-three (31{\%}) participants gave a history of aspirin intolerance and 38 (51{\%}) had a positive nasal L-ASA challenge. Upper airway measures (CT scan score, olfaction, polyp grading, peak nasal inspiratory flow, nasal symptoms, etc.) and lower airway measures (methacholine provocative concentration required to produce a 20{\%} drop in forced expiratory volume in 1 second, effective special airway resistance, and spirometry) were not significantly worse in patients with a positive aspirin challenge. Test sensitivity was 48{\%}, specificity was 52{\%}, positive predictive value was 29{\%}, and negative predictive value was 68{\%}. A regression analysis identified forced expiratory flow at 25-75{\%} (FEF25-75), history of aspirin intolerance, and duration of rhinosinusitis as significant predictors of a positive aspirin challenge.Conclusion: A positive response to nasal L-ASA challenge is not associated with a more severe phenotype of CRSwNP with or without asthma. A history of aspirin intolerance, duration of rhinosinusitis, and FEF25-75 predict a greater response to aspirin. (Am J Rhinol Allergy 26, e89-e93, 2012; doi: 10.2500/ajra.2012.26.3767)",
    author = "Sriram Vaidyanathan and Williamson, {Peter A.} and Lipworth, {Brian J.}",
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    Is a positive nasal lysine-aspirin challenge test associated with a more severe phenotype of chronic rhinosinusitis and asthma? / Vaidyanathan, Sriram; Williamson, Peter A.; Lipworth, Brian J.

    In: American Journal of Rhinology & Allergy, Vol. 26, No. 3, 2012, p. E89-E93.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Is a positive nasal lysine-aspirin challenge test associated with a more severe phenotype of chronic rhinosinusitis and asthma?

    AU - Vaidyanathan, Sriram

    AU - Williamson, Peter A.

    AU - Lipworth, Brian J.

    PY - 2012

    Y1 - 2012

    N2 - Background: Current guidelines recommend a greater use of aspirin challenge testing in the diagnosis of aspirin-intolerant rhinosinusitis and asthma, a disorder with high burden of illness and resistance to treatment. The indications for these tests and their clinical significance remain unclear. This study was designed to characterize the phenotype of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma undergoing a nasal lysine-aspirin (L-ASA) challenge to evaluate which factors strongly predict a positive test.Methods: Seveny-five patients with CRSwNP underwent nasal challenge with 16 mg (total) of L-ASA after 30 minutes of acclimatization and diluent challenge. A positive challenge was defined as a 25% drop in total nasal volume measured by acoustic rhinometry.Results: Twenty-three (31%) participants gave a history of aspirin intolerance and 38 (51%) had a positive nasal L-ASA challenge. Upper airway measures (CT scan score, olfaction, polyp grading, peak nasal inspiratory flow, nasal symptoms, etc.) and lower airway measures (methacholine provocative concentration required to produce a 20% drop in forced expiratory volume in 1 second, effective special airway resistance, and spirometry) were not significantly worse in patients with a positive aspirin challenge. Test sensitivity was 48%, specificity was 52%, positive predictive value was 29%, and negative predictive value was 68%. A regression analysis identified forced expiratory flow at 25-75% (FEF25-75), history of aspirin intolerance, and duration of rhinosinusitis as significant predictors of a positive aspirin challenge.Conclusion: A positive response to nasal L-ASA challenge is not associated with a more severe phenotype of CRSwNP with or without asthma. A history of aspirin intolerance, duration of rhinosinusitis, and FEF25-75 predict a greater response to aspirin. (Am J Rhinol Allergy 26, e89-e93, 2012; doi: 10.2500/ajra.2012.26.3767)

    AB - Background: Current guidelines recommend a greater use of aspirin challenge testing in the diagnosis of aspirin-intolerant rhinosinusitis and asthma, a disorder with high burden of illness and resistance to treatment. The indications for these tests and their clinical significance remain unclear. This study was designed to characterize the phenotype of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) with or without asthma undergoing a nasal lysine-aspirin (L-ASA) challenge to evaluate which factors strongly predict a positive test.Methods: Seveny-five patients with CRSwNP underwent nasal challenge with 16 mg (total) of L-ASA after 30 minutes of acclimatization and diluent challenge. A positive challenge was defined as a 25% drop in total nasal volume measured by acoustic rhinometry.Results: Twenty-three (31%) participants gave a history of aspirin intolerance and 38 (51%) had a positive nasal L-ASA challenge. Upper airway measures (CT scan score, olfaction, polyp grading, peak nasal inspiratory flow, nasal symptoms, etc.) and lower airway measures (methacholine provocative concentration required to produce a 20% drop in forced expiratory volume in 1 second, effective special airway resistance, and spirometry) were not significantly worse in patients with a positive aspirin challenge. Test sensitivity was 48%, specificity was 52%, positive predictive value was 29%, and negative predictive value was 68%. A regression analysis identified forced expiratory flow at 25-75% (FEF25-75), history of aspirin intolerance, and duration of rhinosinusitis as significant predictors of a positive aspirin challenge.Conclusion: A positive response to nasal L-ASA challenge is not associated with a more severe phenotype of CRSwNP with or without asthma. A history of aspirin intolerance, duration of rhinosinusitis, and FEF25-75 predict a greater response to aspirin. (Am J Rhinol Allergy 26, e89-e93, 2012; doi: 10.2500/ajra.2012.26.3767)

    M3 - Article

    VL - 26

    SP - E89-E93

    JO - American Journal of Rhinology & Allergy

    JF - American Journal of Rhinology & Allergy

    SN - 1945-8924

    IS - 3

    ER -