A standardized diagnostic protocol including aspirin challenge identified NSAID-exacerbated respiratory disease in 32.1% of Chinese patients with chronic rhinosinusitis with nasal polyps, compared to 10.0% using clinical history alone.
Observational (n=190)
Single-blind
No
Does a standardized diagnostic protocol including aspirin challenge improve the identification of N-ERD in Chinese patients with CRSwNP compared to clinical history alone?
A full diagnostic protocol including aspirin challenge significantly increases the detection of N-ERD in Chinese patients with CRSwNP compared to clinical history alone.
Absolute Event Rate: 32.1% vs 10%
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.
Xiao et al. (2026) conducted an observational in Chronic rhinosinusitis with nasal polyps (CRSwNP) (n=190). Standardized aspirin challenge protocol (intranasal and oral) vs. Clinical history alone was evaluated on Diagnostic yield of N-ERD. A standardized diagnostic protocol including aspirin challenge identified NSAID-exacerbated respiratory disease in 32.1% of Chinese patients with chronic rhinosinusitis with nasal polyps, compared to 10.0% using clinical history alone.