The impact of endoscopic sinus surgery and aspirin desensitization on psychological burden in aspirin-exacerbated respiratory disease

摘要

Background:Aspirin-exacerbated respiratory disease(AERD)is an aggressive inflammatory disorder of the upper and lower respiratory tract.Corticosteroids,leukotriene modifiers,endoscopic sinus surgery(ESS),aspirin(ASA)desensitization,and biological immu-nomodulators are currently used to treat the disorder.Objective:The objective of this study was to determine the psychosocial impact of ESS and ASA desensitization on AERD patients.Methods:All AERD patients who underwent complete ESS were divided into two cohorts based on ASA desensitization status.The psychosocial metrics of the SNOT-22 were collected and analyzed at the following time points:pre-operative,1-month,3-month,6-month,and 12-month after ESS.Results:One hundred and eighty-four AERD patients underwent ESS from November 2009 to November 2018.From this group,130 patients underwent ASA desensitization(AD cohort)and 54 patients remained non-desensitized(ND cohort).AD patients showed a significantly greater reduction in total SNOT-22 scores over the study period compared to ND patients(p=0.0446).Analysis of SNOT-22 psychosocial metrics showed a significantly greater improvement in patient productivity in the AD cohort when compared to the ND cohort(p=0.0214).Further,a sub-group analysis accounting for subject attrition showed a significantly greater improvement in both productivity and concentration in AD patients when compared to the ND cohort(productivity:p=0.0068;concentration:p=0.0428).Conclusions:ESS followed by ASA desensitization decreases the overall psychosocial burden in AERD patients with a significant improvement in perceived productivity and concentration.This has significant implications given the psychosocial impact of chronic diseases.