TY - JOUR T1 - NSAID-exacerbated respiratory disease (N-ERD): a population study JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00462-2021 SP - 00462-2021 AU - Heidi Andersén AU - Pinja Ilmarinen AU - Jasmin Honkamäki AU - Leena E Tuomisto AU - Hanna Hisinger-Mölkänen AU - Helena Backman AU - Bo Lundbäck AU - Eva Rönmark AU - Tari Haahtela AU - Anssi Sovijärvi AU - Lauri Lehtimäki AU - Päivi Piirilä AU - Hannu Kankaanranta Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/11/18/23120541.00462-2021.abstract N2 - Background Nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent EAACI position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis (CRS) with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD.Methods In 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%.Results The prevalence was 1.4% for N-ERD, and 0.7% for AERD. The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis.The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The sub-phenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the least symptoms.Conclusion We conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interests: Dr. Andersén has nothing to disclose.Conflict of interests: Dr. Ilmarinen is an employee of GlaxoSmithKline. Dr. Ilmarinen reports personal fees from Astra Zeneca, personal fees from Mundipharma, personal fees from Novartis, outside the submitted work.Conflict of interests: Jasmin Honkamäki has nothing to disclose.Conflict of interests: Dr. Tuomisto reports personal fees and non-financial support from Boehringer-Ingelheim, personal fees from Astra Zeneca, outside the submitted work; .Conflict of interests: Hanna Hisinger-Mölkänen is employed by GlaxoSmithKline as Medical Advisor. However, in this epidemiological work this employment does not to our understanding form any relevant conflict of interest.Conflict of interests: Dr. Backman reports personal fees from Astra Zeneca, personal fees from Boehringer Ingelheim, outside the submitted work; .Conflict of interests: Dr. Lundbäck reports grants from AstraZeneca, grants from ThermoFisher, personal fees from Sanofi, outside the submitted work; .Conflict of interests: Dr. Rönmark has nothing to disclose.Conflict of interests: Dr. Haahtela reports lecturing fees from GSK, Mundipharma, Orion Pharma, and Sanofi, outside the submitted work.Conflict of interests: Dr. Sovijärvi has nothing to disclose.Conflict of interests: Dr. Lehtimäki has nothing to disclose.Conflict of interests: Dr. Piirilä has nothing to disclose.Conflict of interests: Dr. Kankaanranta reports personal fees and non-financial support from AstraZeneca, personal fees from Chiesi Pharma AB, personal fees and non-financial support from Boehringer-Ingelheim, personal fees from Novartis, personal fees from Mundipharma, personal fees and non-financial support from Orion Pharma, personal fees from SanofiGenzyme, personal fees from GlaxoSmithKline, outside the submitted work; . ER -