Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease.

BACKGROUND AND OBJECTIVE: Safer and less time-consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) have been sought for the diagnosis of aspirin-exacerbated respiratory disease (AERD). Nasal challenges with various nonsteroidal anti-inflammatory drugs and assessment methods have been developed. Objective: Our objective was to evaluate the utility and safety of nasal ketorolac challenge (NKC) using acoustic rhinometry in patients with suspected AERD. METHODS: The study population comprised 36 patients with suspected AERD. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge result was defined as an increase of ≥30% in nasal symptoms (recorded using a visual analog scale) and a 30% drop in the sum of the volumes of both nasal cavities at 2-8 cm. Patients with a negative NKC result underwent SBPCOC with aspirin (cumulative dose of 750 mg). RESULTS: A naso-ocular reaction during NKC was detected in 21 patients. Four patients also developed mild asthma exacerbations (although only 1 experienced a decrease in FEV1 >15%). No other significant adverse events occurred. The remaining 15 patients with a negative NKC result had a negative response during aspirin SBPCOC. CONCLUSIONS: NKC assessed using acoustic rhinometry is a reliable method for the study of patients with AERD. We suggest that NKC assessed with acoustic rhinometry was useful and safe for selection of candidates for safe oral aspirin challenge.

Nasal ketorolac challenge using acoustic thinometry in patients with aspirin-exacerbated respiratory disease

Background: Safer and less time-consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) have been sought for the diagnosis of aspirin-exacerbated respiratory disease (AERD). Nasal challenges with various nonsteroidal anti-inflammatory drugs and assessment methods have been developed. Objective: Our objective was to evaluate the utility and safety of nasal ketorolac challenge (NKC) using acoustic rhinometry in patients with suspected AERD. Methods: The study population comprised 36 patients with suspected AERD. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge result was defined as an increase of ≥30% in nasal symptoms (recorded using a visual analog scale) and a 30% drop in the sum of the volumes of both nasal cavities at 2-8 cm. Patients with a negative NKC result underwent SBPCOC with aspirin (cumulative dose of 750 mg). Results: A naso-ocular reaction during NKC was detected in 21 patients. Four patients also developed mild asthma exacerbations (although only 1 experienced a decrease in FEV1 >15%). No other significant adverse events occurred. The remaining 15 patients with a negative NKC result had a negative response during aspirin SBPCOC. Conclusion: NKC assessed using acoustic rhinometry is a reliable method for the study of patients with AERD. We suggest that NKC assessed with acoustic rhinometry was useful and safe for selection of candidates for safe oral aspirin challenge (AU)

Introducción: El test de exposición simple ciego controlado con placebo (TEC) con aspirina es el patrón-oro para el diagnóstico de la enfermedad respiratoria exacerbada por aspirina (EREA), aunque presenta un riesgo elevado de reacciones durante su realización. Por este motivo, se han desarrollado diferentes procedimientos de provocación nasal con aspirina, lisina y ketorolaco. Objetivo: Evaluar la utilidad y la seguridad del test inhalatorio nasal con ketorolaco (TNK) usando un rinómetro acústico en pacientes con sospecha de EREA. Métodos: Se incluyeron 36 pacientes con sospecha de EREA. El TNK se realizó con placebo (solución salina) y 13 mg de ketorolaco instilado como aerosol en ambas fosas nasales. Un test de exposición positivo se definió como un aumento del 30% o más de los síntomas nasales registrados mediante una escala analógica visual y un descenso mayor del 30% en la suma de ambos volúmenes de las cavidades nasales entre 2 a 8 cm del vestíbulo nasal. Si el TNK era negativo, los pacientes se sometían a un TEC con 750 mg de aspirina (en dosis acumulativas). Resultados: Veintiún pacientes presentaron una reacción nasoocular durante el TNK. Cuatro de ellos presentaron síntomas de asma bronquial (aunque solo uno mostró un descenso del FEV1> 15%), pero no se produjeron otros acontecimientos adversos significativos. Los 15 pacientes restantes que tuvieron un TNK negativo, tuvieron una respuesta negativa durante el TEC con aspirina. Conclusión: El TNK evaluado mediante rinómetro acústico es un método fiable para el estudio de pacientes con sospecha de EREA (AU)