1. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)--a EAACI position paper
- Author
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María José Torres, Hae-Sim Park, Masami Taniguchi, Marek Sanak, Aleksandra Wardzyńska, Joaquim Mullol, Ioana Agache, Matteo Bonini, Marek L. Kowalski, Mario Sánchez-Borges, Sevim Bavbek, Arzu Bakirtas, Ludger Klimek, Miguel Blanca, Enrico Heffler, Ewa Nizankowska-Mogilnicka, Glenis Scadding, Andrew A. White, Grazyna Bochenek, Silvia Sanchez-Garcia, and Tanya M. Laidlaw
- Subjects
0301 basic medicine ,medicine.medical_specialty ,nasal polyps...) sinusitis ,asthma treatment ,sinusitis ,Drug allergy ,Respiratory Tract Diseases ,Immunology ,Settore MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO ,ENT (rhinitis ,03 medical and health sciences ,0302 clinical medicine ,Eosinophilic ,medicine ,nasal polyps…) ,Humans ,Immunology and Allergy ,Nasal polyps ,Sinusitis ,Intensive care medicine ,Asthma ,Rhinitis ,ENT (rhinitis, sinusitis, nasal polyps…) ,Aspirin ,business.industry ,AERD asthma asthma treatment drug allergy ENT (rhinitis ,Respiratory disease ,Anti-Inflammatory Agents, Non-Steroidal ,Disease Management ,asthma ,medicine.disease ,AERD ,030104 developmental biology ,030228 respiratory system ,drug allergy ,Position paper ,Asthma, Aspirin-Induced ,business ,Algorithms ,medicine.drug - Abstract
NSAID-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence-based recommendations for the diagnosis and management of N-ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N-ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N-ERD. Recommendations for the most effective management of a patient with N-ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub-phenotypes and emerging sub-endotypes of N-ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N-ERD and unmet needs, which should be addressed in the future.
- Published
- 2019