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NSAID-exacerbated respiratory disease: a population study

Heidi Andersén, Pinja Ilmarinen, Jasmin Honkamäki, Leena E. Tuomisto, Hanna Hisinger-Mölkänen, Helena Backman, Bo Lundbäck, Eva Rönmark, Tari Haahtela, Anssi Sovijärvi, Lauri Lehtimäki, Päivi Piirilä, Hannu Kankaanranta
ERJ Open Research 2022 8: 00462-2021; DOI: 10.1183/23120541.00462-2021
Heidi Andersén
1Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland
2Thoracic Oncology Unit, Karolinska University Hospital, Tema Cancer, Stockholm, Sweden
3Oncology Unit, Vaasa Keskussairaala, Vaasa, Finland
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  • ORCID record for Heidi Andersén
  • For correspondence: heidi.andersen@tuni.fi
Pinja Ilmarinen
1Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland
4Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Jasmin Honkamäki
1Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland
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Leena E. Tuomisto
4Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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  • ORCID record for Leena E. Tuomisto
Hanna Hisinger-Mölkänen
5Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Helena Backman
6Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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  • ORCID record for Helena Backman
Bo Lundbäck
7Dept of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Eva Rönmark
6Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Tari Haahtela
5Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Anssi Sovijärvi
5Faculty of Medicine, University of Helsinki, Helsinki, Finland
8Unit of Clinical Physiology, Dept of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
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Lauri Lehtimäki
1Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland
9Allergy Centre, Tampere University Hospital, Tampere, Finland
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Päivi Piirilä
5Faculty of Medicine, University of Helsinki, Helsinki, Finland
8Unit of Clinical Physiology, Dept of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
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Hannu Kankaanranta
1Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland
4Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
7Dept of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • FIGURE 1
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    FIGURE 1

    Proportional Venn diagram describing the overlap of asthma, rhinitis, nonsteroidal anti-inflammatory drug (NSAID)-induced dyspnoea, the definition of NSAID-exacerbated respiratory disease (N-ERD) and how it differs from aspirin-exacerbated respiratory disease (AERD) and NSAID-induced dyspnoea without N-ERD.

  • FIGURE 2
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    FIGURE 2

    The prevalence of respiratory symptoms in nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) (n=110) and asthma without N-ERD (n=818). Comparison between groups was made using Pearson's Chi-squared test.

  • FIGURE 3
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    FIGURE 3

    The prevalence of respiratory symptoms in nonsteroidal anti-inflammatory drug (NSAID)-induced dyspnoea without co-existing disease but with rhinitis or asthma; the latter two being NSAID-exacerbated respiratory disease (N-ERD) subgroups and the last one being part of aspirin-exacerbated respiratory disease. Comparison between groups was made using Pearson's Chi-squared test with the z-test.

Tables

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  • TABLE 1

    Characteristics of nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), asthma, rhinitis and NSAID-induced dyspnoea without N-ERD

    N-ERDAsthma without N-ERDRhinitis without asthma or N-ERDNSAID-induced dyspnoea without N-ERDp-value
    Patients110818316822
    Age years52±1446±15*46±14*53±16<0.001
    Female72 (65.5)460 (56.2)1767 (55.8)16 (72.7)0.090
    BMI kg·m−227.3±5.726.7±5.226.1±7.426.6±15.50.049
    Age at asthma diagnosis years32±1725±18*NANA0.021
    Asthma diagnosis
     <12 years10 (16.4)235 (30.1)NANA0.027
     12–39 years24 (39.3)334 (42.8)
     ≥40 years27 (44.3)212 (27.1)
    Physician-diagnosed allergic rhinitis48 (43.6)471 (57.6)*1264 (39.6)0 (0.0)*<0.001
    Physician-diagnosed COPD17 (15.5)67 (8.2)68 (2.1)*0 (0.0)<0.001
    Family history of asthma53 (48.2)355 (43.4)823 (26.0)*5 (22.7)<0.001
    Never-smoker49 (44.5)383 (47.2)*1689 (53.3)6 (27.3)<0.001
    Current smoker24 (21.8)192 (23.5)724 (22.9)10 (45.5)
    Ex-smoker37 (33.6)240 (29.3)*755 (23.8)6 (27.3)
    Occupational exposure to VGDF48 (45.7)308 (38.8)1064 (34.2)5 (23.8)0.007
    Childhood exposure to farming environment43 (39.8)210 (26.2)*702 (22.4)*5 (29.4)<0.001

    Data are presented as n, mean±sd or n (%), unless otherwise stated. Missing data in the N-ERD group: body mass index (BMI) n=2, occupational exposure to vapours, gases, dusts and fumes (VGDF) n=3, childhood exposure to farming environment n=2. ANOVA was used for continuous variables with Tukey's post hoc test to determine statistically significant differences and multigroup comparisons. Pearson's Chi-squared test with the z-test was used for categorical variables. NA: not applicable. *: p<0.05 versus N-ERD group.

    • TABLE 2

      Factors associated with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) determined by multivariable binary logistic regression

      Crude OR (95% CI)Adjusted# OR (95% CI)
      Age
       20–39 years (ref.)
       40–59 years2.15 (1.25–3.68)2.11 (1.19–3.76)
       60–69 years2.90 (1.68–4.99)3.08 (1.68–5.64)
      Female sex1.57 (1.06–2.33)1.46 (0.94–2.28)
      Family history of asthma2.98 (2.04–4.34)2.34 (1.53–3.57)
      Family history of allergic rhinitis2.46 (1.68–3.59)2.47 (1.60–3.83)
      Cumulative exposure¶
       0 exposures (ref.)
       1 exposure1.63 (0.97–2.75)1.49 (0.86–2.59)
       2 exposures2.65 (1.53–4.57)2.41 (1.34–4.34)
       3 exposures3.83 (1.98–7.39)3.68 (1.82–7.46)
      BMI
       <25 kg·m−2 (ref.)
       25–29.99 kg·m−21.27 (0.82–1.98)1.02 (0.64–1.64)
       ≥30 kg·m−21.72 (1.05–2.81)1.14 (0.67–1.95)
      Childhood exposure to farming environment1.75 (1.18–2.57)1.38 (0.90–2.12)

      Ref.: reference category (without N-ERD); BMI: body mass index. #: adjusted to all variables in the model; ¶: cumulative exposure was classified from zero to three exposures calculating smoking (current or ex-smoking), secondhand smoke (smoke exposure at home or at work) and occupational exposure to vapours, gases, dusts and fumes.

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        Supplementary material 00462-2021.supplement

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      NSAID-exacerbated respiratory disease: a population study
      Heidi Andersén, Pinja Ilmarinen, Jasmin Honkamäki, Leena E. Tuomisto, Hanna Hisinger-Mölkänen, Helena Backman, Bo Lundbäck, Eva Rönmark, Tari Haahtela, Anssi Sovijärvi, Lauri Lehtimäki, Päivi Piirilä, Hannu Kankaanranta
      ERJ Open Research Jan 2022, 8 (1) 00462-2021; DOI: 10.1183/23120541.00462-2021

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      NSAID-exacerbated respiratory disease: a population study
      Heidi Andersén, Pinja Ilmarinen, Jasmin Honkamäki, Leena E. Tuomisto, Hanna Hisinger-Mölkänen, Helena Backman, Bo Lundbäck, Eva Rönmark, Tari Haahtela, Anssi Sovijärvi, Lauri Lehtimäki, Päivi Piirilä, Hannu Kankaanranta
      ERJ Open Research Jan 2022, 8 (1) 00462-2021; DOI: 10.1183/23120541.00462-2021
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