Multiple risk factors drive NSAID-exacerbated respiratory disease with asthma

Key takeaways:

• Univariate logistic regression analysis found 23 covariates associated with NERD in patients with asthma.
• Overweight was the only factor associated with decreased risk for NERD.

Multiple risk factors were associated with NSAID-exacerbated respiratory disease, which itself is associated with uncontrolled or severe asthma, according to a study published in Clinical and Translational Allergy.

Early recognition of these risk factors may help manage disease burden, Alma Helevä, research assistant in the department of allergy of Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, and colleagues wrote.

The study used data from the Adult Asthma in Finland population-based matched case-control study, performed in 1996 and 1997, of 1,350 adults with asthma (62.1% women) aged 30 years and older (mean age, 54.39 years).

The cohort included 153 patients (11.3%; mean age, 54.15 years; 18.3% men) with NSAID-exacerbated respiratory disease (NERD). Also, 11.2% of the full cohort and 19% of the NERD group had severe asthma.

Unadjusted analysis found statistically significant associations (P < .05) between asthma with NERD and 23 factors, such as female sex; overweight; allergic respiratory symptoms; several cases of physician-diagnosed sinusitis and bronchitis in the previous year; nasal polyps; ever smoking and secondhand smoke exposure in the home; and allergic dermatitis, rhinitis and rhinoconjunctivitis.

Compared with the asthma without NERD phenotype, a multivariable regression model found significant associations (P < .05) between asthma with NERD and:

• female sex (OR = 2.5; 95% CI, 1.52-4.09);
• overweight (OR = 0.65; 95% CI, 0.45-0.94);
• allergic respiratory symptoms (OR = 1.91; 95% CI, 1.21-3.02);
• self‐reported difficult asthma (OR = 2.21; 95% CI, 1.28-3.82);
• nasal polyps (OR = 1.76; 95% CI, 1.07-2.9);
• secondhand tobacco smoke exposure at home (OR = 2.38; 95% CI, 1.18-4.79);
• three or more older siblings (OR = 1.63; 95% CI, 1.10-2.41); and
• osteoarthritis (OR = 1.9; 95% CI, 1.23-2.95).

The researchers further divided the cohort into group 1, comprising 667 younger patients born between 1943 and 1966 (age, 31-54 years), including 80 with NERD; and group 2, comprising 683 older patients (age, 55-93 years) born between 1904 and 1942, including 73 with NERD.

In group 1, multivariable analysis found self-reported difficult asthma (OR = 3.11; 95% CI, 1.47-6.57) and nasal polyps (OR = 1.99; 95% CI, 1.03-3.84) were significantly associated with NERD. High BMI also showed a trend toward decreased risk for NERD in this group (OR = 0.65; 95% CI, 0.39-1.08).

Group 2 exhibited significant associations between NERD and female sex (OR = 4.29; 95% CI, 1.99-9.25), allergic respiratory symptoms (OR = 2.22; 95% CI, 1.14-4.3) and osteoarthritis (OR = 2.04; 95% CI, 1.2-3.47), also in the multivariable analysis.

Additionally, the multivariable analysis found significant associations between NERD with uncontrolled asthma and allergic respiratory symptoms (OR = 2.75; 95% CI, 1.21-6.23) and self-reported difficult asthma (OR = 4.44; 95% CI, 1.63-12.11).

Among patients who did not have NERD, there were significant associations between uncontrolled asthma and:

• female sex (OR = 0.55; 95% CI, 0.42-0.72);
• onset of asthma age at 40 years and older (OR = 1.92; 95% CI, 1.4-2.63);
• allergic respiratory symptoms (OR = 1.3; 95% CI, 1-1.69);
• several physician-diagnosed bronchitis in the previous year (OR = 1.56; 95% CI, 1.11-2.2);
• self-reported difficult asthma (OR = 5.08; 95% CI,3.01-8.59);
• oral corticosteroid use regularly or in courses (OR = 1.93; 95% CI, 1.44-2.59);
• recurrent respiratory infections in adulthood (OR = 1.49; 95% CI, 1.14-1.96);
• back disease (OR = 1.38; 95% CI, 1.03-1.84); and
• physician-diagnosed pneumonia in the previous year (OR = 2.62; 95% CI, 1.04-6.58).

Overall, the researchers concluded that female sex, allergic respiratory symptoms, difficult asthma, nasal polyps, secondhand smoke exposure at home, three or more older siblings and osteoarthritis were independently increased risk for asthma with NERD, whereas overweight decreased this risk.

These factors reinforce the need for smoking cessation in the living environments of patients with NERD, the researchers wrote, as well as the importance of early detection and management of these risk factors in preventing severe adult-onset asthma in these patients.