Few Patients With N-ERD Can Achieve Adequate Lung Function, Asthma Control With High ISC Dosage, Study Finds

A study that described the lung function and clinical control of patients with asthma with nonsteroidal anti-inflammatory drug–exacerbated respiratory disease (N-ERD), found only one-third of these patients can gradually achieve adequate lung function and good asthma control with high inhaled corticosteroids (ICS) dosage.

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“In the present real-life study, we described asthma clinical control and lung function in Mexican patients with N-ERD over time according to the GINA-2014 [Global Initiative for Asthma 2014] guidelines,” wrote the researchers of the study. “We demonstrated that N-ERD patients had better lung function and clinical control than asthma patients.”

The full descriptive analysis is published in the Journal of Asthma and Allergy.

N-ERD has been considered a severe asthma phenotype for many years and requires the use of multiple medicines or large doses for asthma control. However, the standard therapy for asthma control in patients with N-ERD has only been described to diminish bronchial symptoms during aspirin oral challenge with the combination of ICS and long-acting β₂-agonists (LABA; ICS/LABA) and antileukotrienes.

Between 2014 and 2015, the researchers compared all variables from patients with N-ERD and asthma at baseline, as well as 1, 2, and 3 years after treatment. A N-ERD diagnosis was defined as a patient with asthma, nasosinusal polyposis, and hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Only patients who completed 3 years of follow-up were selected for the study.

The clinical control of asthma was defined according to GINA-2014 guidelines, including the presence of asthma symptoms in the last 4 weeks, nocturnal awakening, activity limitation, and the use of rescue medication and their frequency by numbers of days of the week. Additionally, lung function was evaluated using guidelines established by the American Thoracic Society and treatment was chosen based on GINA guidelines, using the dose of inhaled steroids, as well as the need for the use of leukotriene receptor antagonists.

The study included a total of 120 patients with N-ERD and 160 patients with asthma. Only 143 completed the medical follow-up for the 3 years.

Baseline comparisons showed the N-ERD group had better basal lung function than the asthma group (P < .01), and the asthma group used higher doses of ICS than the N-ERD group (52.4% vs 30.5%; P = .01) and short-term OCS use (52.4% vs 30.5%; P < .01).

On the other hand, N-ERD patients required more use of leukotriene receptor antagonists (LTRAs) compared with asthma patients (29.3% vs 5.9%; P < .01). Furthermore, this group was found to have better clinical control than the asthma group (62.1% vs 34.1%; P < .01).

During follow-up, patients in the N-ERD group maintained normal lung function values. However, lung function improved in the asthma group after 1-year (P < .01). Similarly, these patients had a lower use of high doses of ICS (52.4% vs 33%; P < .05) and short-term OCS (67.6% vs 20.6%; P < .01) in the asthma group. However, patients in the N-ERD group needed more LTRAs (P < .02) during the study period, in which one-third of these patients had to use a combination of 2 drugs to maintain this control. At the second year and beyond, clinical control of asthma was similar in both groups (P > .05).

The researchers of the study acknowledged some limitations to the study, including selection bias, information bias, recall bias, and detection bias. Despite these limitations, the researchers believe the study estimates that only a third of patients need high dosages of ICS, with a small proportion requiring a second drug to maintain asthma control during the 3-year follow-up.

Reference

Pavón-Romero GF, Falfán-Valencia R, Gutiérrez-Quiroz KV, et al. Lung function and asthma clinical control in N-ERD patients, three-year follow-up in the context of real-world evidence. J Asthma Allergy. 2023;16:937-950. doi:10.2147/jaa.s418802