与NSAID加重呼吸道疾病症状序列相关的性别、种族、BMI和环境暴露
2023/08/28
摘要
背景：非甾体抗炎药加重呼吸道疾病（N-ERD）有三种症状：鼻息肉、哮喘和NSAID超敏反应。对症状发生的时间和疾病进展知之甚少。
目的：本研究的目的是描述N-ERD的疾病进展。
方法：对N-ERD患者进行前瞻性访谈，并根据其首次出现N-ERD症状（哮喘、鼻息肉、NSAID超敏反应或同时出现）分为四组。研究了四组患者特征的相关性，以及“哮喘优先”组的相关性。
结果：患者（n=240）大多为女性（68%），自称非白人（77%）。一半（n=119）报告哮喘是n-ERD三联征中最早的症状。与其他组相比，“哮喘优先”与发病年龄较小（25岁，SE±1.3，p<0.001）和BMI较高（OR=1.3，95%CI 1.06-1.7，p=0.02）有关。在该组中，发病年龄<20岁与女性、拉丁裔和较高的BMI相关（均p<0.05）。“NSAID敏感性优先”组与男性（OR=3.3，95%CI 1.5-7.4，p=0.004）和污染暴露（OR=4.4，95%CI 1.6-11.9，p=0.003）显著相关。在最初出现时，27%的患者不知道自己的N-ERD诊断。与白人相比，黑人和拉丁裔患者更有可能不知道自己的N-ERD诊断（p=0.003）。中位诊断延迟为3年（IQR 0-5）。
结论：在该队列中，N-ERD的发病和进展高度可变，性别、BMI、种族和民族以及环境暴露与疾病模式和诊断延迟显著相关。
Sex, ethnicity, BMI, and environmental exposures associated with NSAID-Exacerbated Respiratory Disease symptom sequence
Kelley Nicole Dages, Olufemi Sofola-James, Esha Sehanobish, Prudhvi Regula, Chien-Chang Chen, Sergio Elias Chiarella, Rohit Dilip Divekar, Hillel W Cohen, Elina Jerschow
Abstract
Background:Nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD) has a triad of symptoms: nasal polyposis, asthma, and NSAID hypersensitivity. Little is known about symptom timing and disease progression.
Objective: The aim of this study is to characterize disease progression in N-ERD.
Methods: Patients with N-ERD were prospectively interviewed and classified into four groups based on their first symptom at initial N-ERD onset (asthma, nasal polyps, NSAID hypersensitivity, or all concurrently). Associations of patient characteristics with the four groups were examined, along with associations within the "asthma first" group.
Results: Patients (n=240) were mostly female (68%) and self-identified as non-White (77%). Half (n=119) reported asthma as the earliest symptom in the N-ERD triad. Compared to other groups, "asthma first" was associated with younger age of onset (25 years, SE ±1.3, p<0.001) and higher BMI (OR=1.3, 95%CI 1.06-1.7, p=0.02). In this group, age of onset <20 years was associated with female sex, Latino ethnicity, and higher BMI (all p<0.05). The "NSAID-sensitivity first" group was significantly associated with male sex (OR=3.3, 95%CI 1.5-7.4, p=0.004) and pollution exposure (OR=4.4, 95%CI 1.6-11.9, p=0.003). At the initial presentation, 27% of patients were unaware of their N-ERD diagnosis. Black and Latino patients were more likely to be unaware of their N-ERD diagnosis compared to White (p=0.003). Median diagnostic delay was 3 years (IQR 0-5).
Conclusions: In this cohort, N-ERD is highly variable in onset and progression, with sex, BMI, race and ethnicity, and environmental exposures significantly associated with disease patterns and diagnostic delay.
背景：非甾体抗炎药加重呼吸道疾病（N-ERD）有三种症状：鼻息肉、哮喘和NSAID超敏反应。对症状发生的时间和疾病进展知之甚少。
目的：本研究的目的是描述N-ERD的疾病进展。
方法：对N-ERD患者进行前瞻性访谈，并根据其首次出现N-ERD症状（哮喘、鼻息肉、NSAID超敏反应或同时出现）分为四组。研究了四组患者特征的相关性，以及“哮喘优先”组的相关性。
结果：患者（n=240）大多为女性（68%），自称非白人（77%）。一半（n=119）报告哮喘是n-ERD三联征中最早的症状。与其他组相比，“哮喘优先”与发病年龄较小（25岁，SE±1.3，p<0.001）和BMI较高（OR=1.3，95%CI 1.06-1.7，p=0.02）有关。在该组中，发病年龄<20岁与女性、拉丁裔和较高的BMI相关（均p<0.05）。“NSAID敏感性优先”组与男性（OR=3.3，95%CI 1.5-7.4，p=0.004）和污染暴露（OR=4.4，95%CI 1.6-11.9，p=0.003）显著相关。在最初出现时，27%的患者不知道自己的N-ERD诊断。与白人相比，黑人和拉丁裔患者更有可能不知道自己的N-ERD诊断（p=0.003）。中位诊断延迟为3年（IQR 0-5）。
结论：在该队列中，N-ERD的发病和进展高度可变，性别、BMI、种族和民族以及环境暴露与疾病模式和诊断延迟显著相关。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 Aug 2;S2213-2198(23)00809-7. doi: 10.1016/j.jaip.2023.07.035.)
(J Allergy Clin Immunol Pract. 2023 Aug 2;S2213-2198(23)00809-7. doi: 10.1016/j.jaip.2023.07.035.)
Sex, ethnicity, BMI, and environmental exposures associated with NSAID-Exacerbated Respiratory Disease symptom sequence
Kelley Nicole Dages, Olufemi Sofola-James, Esha Sehanobish, Prudhvi Regula, Chien-Chang Chen, Sergio Elias Chiarella, Rohit Dilip Divekar, Hillel W Cohen, Elina Jerschow
Abstract
Background:Nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD) has a triad of symptoms: nasal polyposis, asthma, and NSAID hypersensitivity. Little is known about symptom timing and disease progression.
Objective: The aim of this study is to characterize disease progression in N-ERD.
Methods: Patients with N-ERD were prospectively interviewed and classified into four groups based on their first symptom at initial N-ERD onset (asthma, nasal polyps, NSAID hypersensitivity, or all concurrently). Associations of patient characteristics with the four groups were examined, along with associations within the "asthma first" group.
Results: Patients (n=240) were mostly female (68%) and self-identified as non-White (77%). Half (n=119) reported asthma as the earliest symptom in the N-ERD triad. Compared to other groups, "asthma first" was associated with younger age of onset (25 years, SE ±1.3, p<0.001) and higher BMI (OR=1.3, 95%CI 1.06-1.7, p=0.02). In this group, age of onset <20 years was associated with female sex, Latino ethnicity, and higher BMI (all p<0.05). The "NSAID-sensitivity first" group was significantly associated with male sex (OR=3.3, 95%CI 1.5-7.4, p=0.004) and pollution exposure (OR=4.4, 95%CI 1.6-11.9, p=0.003). At the initial presentation, 27% of patients were unaware of their N-ERD diagnosis. Black and Latino patients were more likely to be unaware of their N-ERD diagnosis compared to White (p=0.003). Median diagnostic delay was 3 years (IQR 0-5).
Conclusions: In this cohort, N-ERD is highly variable in onset and progression, with sex, BMI, race and ethnicity, and environmental exposures significantly associated with disease patterns and diagnostic delay.
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哮喘相关的复杂特征的重新识别
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过敏性鼻炎和哮喘控制与EQ-5D-5L结构域损害：一项MASK-air真实世界研究
