Dietary Fatty Acid Modification for the Treatment of Aspirin-Exacerbated Respiratory Disease: A Prospective Pilot Trial

Abstract

Background: The high levels of eicosanoid production and the clinical efficacy of leukotriene-modifying pharmacotherapies for patients with aspirin-exacerbated respiratory disease (AERD) suggest that other interventions targeting arachidonic acid dysregulation may also improve disease control.

Objective: To assess the utility of a high omega-3/low omega-6 diet for the treatment of AERD.

Methods: Prospective, nonblinded dietary intervention in 10 adult patients with AERD at Brigham and Women's Hospital in Boston, MA. The primary objective was for subjects to reduce dietary omega-6 fatty acid consumption to less than 4 g/d and increase omega-3 intake to more than 3 g/d. The primary outcome was change in urinary leukotriene E₄, with changes in other eicosanoids, platelet activation, lung function, and patient-reported questionnaires also assessed.

Results: Of the 10 subjects who screened for the study, all 10 completed the dietary intervention. Urinary leukotriene E₄ decreased by 0.17 ng/mg (95% CI, -0.29 to -0.04; P = .02) and tetranor prostaglandin D-M decreased by 0.66 ng/mg creatinine (95% CI, -1.21 to -0.11; P = .02). There was a 15.1-point reduction in the 22-item Sino-Nasal Outcome Test score (95% CI, -24.3 to -6.0; P = .01), a 0.27-point reduction in the 7-item Asthma Control Questionnaire score (95% CI, -0.52 to -0.03; P = .03), and no change in FEV₁ % predicted (P = .92) or forced vital capacity % predicted (P = .74). All patients lost some weight over the 2-week intervention period, and there were no diet-associated adverse events.

Conclusions: A high omega-3/low omega-6 diet may be an appropriate adjunct treatment option for patients with AERD.

Keywords: AERD; Aspirin; Aspirin-exacerbated respiratory disease; Asthma; Diet; Fatty acids; LTE(4); NSAIDs; Nasal polyps; Omega-3; Omega-6; Samter's Triad.

Figure 1. Omega-3 and omega-6 FA intake during two-week dietary intervention

Change in average daily nutritional intake of omega-6 (TOP) and omega-3 (BOTTOM) fatty acids are shown. Individual data points are shown with means for each phase.

Figure 2. Urinary LTE₄ and PGD-M levels during two-week dietary intervention

Change in uLTE₄ (TOP) and uPGD-M (BOTTOM) levels are shown. Individual data points are shown with means for each phase.

Figure 3. SNOT-22 and ACQ scores during two-week dietary intervention

Change in patient-reported Sino-Nasal Outcome Test-22 (TOP) and Asthma Control Questionnaire (BOTTOM) scores are shown. Individual data points are shown with means for each phase.