Diagnostic Role of Aspirin Challenge in NSAID-Exacerbated Respiratory Disease: A Prospective Single-Center Study in China.

PURPOSE: Epidemiological data on non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) remain unknown in most countries, especially China. Moreover, aspirin challenge tests are not yet routinely used in clinical practice. To address these gaps, this study aimed to evaluate the diagnostic value of the aspirin challenge in identifying N-ERD among Chinese patients with chronic rhinosinusitis with nasal polyps (CRSwNP), using the algorithm proposed by the latest European Academy of Allergy and Clinical Immunology position paper.

METHODS

Patients with CRSwNP were evaluated through a standardized diagnostic protocol, including clinical history review, intranasal aspirin challenge (IAC), and, if IAC was negative, a subsequent oral aspirin challenge (OAC).

RESULTS

Among 190 CRSwNP patients (49.5% with asthma), N-ERD was diagnosed in 61 (32.1%). Of these, 19 (10.0%) were diagnosed based on clinical history, while 42 (22.1%) were diagnosed by aspirin challenge. Among challenge-positive patients, 34 reacted to IAC and 8 to OAC. Of the 137 patients with negative IAC results, 129 were tested negative by a subsequent OAC, yielding a negative predictive value of 94.2% (129/137) for IAC in the diagnosis of N-ERD. Mild asthma exacerbations occurred in 3 of 171 patients (1.75%) during IAC, all of whom had moderate-to-severe asthma.

CONCLUSIONS

This is the first study to report that 32.1% of Chinese CRSwNP patients were diagnosed with N-ERD when a full diagnostic protocol was applied, compared to 10.0% based on history alone. These findings emphasize the diagnostic value of aspirin challenge and support IAC as an initial tool in the evaluation of N-ERD in CRSwNP.