Use of a composite symptom score during challenge in patients with suspected aspirin-exacerbated respiratory disease

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Kevin A. Cook, Brian D. Modena, Nathan E. Wineinger, Katharine M. Woessner, Ronald A. Simon, Andrew A. White
BackgroundAspirin-exacerbated respiratory disease is characterized by asthma, chronic rhinosinusitis, nasal polyposis, and sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs. Confirmation of the diagnosis requires provocation challenge with resulting upper and/or lower airways reactivity. Currently, determination of a positive challenge result is based solely on clinical judgment that synthesizes subjective symptoms and objective measures, as a concomitant increase in nasal or bronchial airways resistance is measured in only half of patients.ObjectiveTo describe a quantitative scoring system, based on symptoms typically reported during provocation challenge, used to identify a positive challenge result.MethodsA total of 115 patients were asked to record 10 symptoms, rated on a scale from 1 (mild) to 10 (most severe), at regular intervals during intranasal ketorolac with modified oral aspirin challenge performed in our office. Composite scores, a simple sum of all individual scores, were calculated at each time point and compared with baseline, prechallenge values.ResultsOne hundred of the 115 patients were determined to have a positive challenge result. A statistically significant difference in composite scores was observed in reactors vs nonreactors. All nonreactors recorded an increase in composite score of less than 5, whereas 69% of reactors recorded an increase of 5 or more.ConclusionOur 10-symptom composite score provides a quantitative and comparable measure of symptoms that typically present during a challenge with a positive result. Although an external validation is needed to confirm its diagnostic performance characteristics, a change in composite score of 5 or more appears to be specific to reactors.



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