Nasal Responses and Safety of L-ASA Nasal Provocation Test in a Large Series of Patients with NSAID-Exacerbated Respiratory Disease (NERD)

Nasal provocation test with lysine-aspirin (NPT-LASA) is a useful tool for the diagnosis of patients with NSAID-exacerbated respiratory disease (NERD). The aim was to evaluate the clinical characteristics, nasal/bronchial response and safety of the test in a large series of patients with NERD. Patients (referred from 2010-2015) with suspected NERD underwent a clinical evaluation. Later, NPT with saline and 29 mg of L-ASA was performed in both nostrils. Visual analogical scale (VAS) for nasal/bronchial, volume 2-6 by acoustic rhinometry (AR) and FEV1 measurements were performed at baseline and at 15, 60 and 120 min. Test was positive if an increase of ≥30% in VAS and ≥30% fall in vol 2-6 cm occurred. One hundred and thirty seven patients participated (42.2±15.5 yrs, 64.2% women). Atopy was present in 70% of subjects, with asthma (61.3%) and rhinitis (77%). NPT-LASA was positive in 96 subjects (70.1%), with 35.8% of positive responses at 15 min, an additional 23.8% positive at 60 min and the remaining 40.4% at 120 min. Changes in VAS and vol 2-6 were significant between baseline and 15, 60 and 90 minutes for patients with positive NPT (p<0.001). No systemic reactions were observed. There were no significant differences between baseline FEV1 values and all other timepoints (p=0.176) in patients with positive NPT-LASA. Only 2 patients (1.45%) had a FEV1 fall >20% with mild symptoms that responded well to Terbutaline. NPT-LASA is very well tolerated and can be safely used.