Background: Aspirin-exacerbated respiratory disease (AERD) is a subtype of chronic sinusitis comprised of asthma, chronic rhinosinusitis with nasal polyps, and a non-IgE hypersensitivity to cyclooxygenase-1 inhibitors. AERD is typically refractory to medical and often surgical management and causes significant quality-of-life concerns for patients.
Objective: This study aimed to retrospectively assess the rhinologic disease-specific outcomes as well as quality-of-life metrics in a cohort of AERD patients who medically manage their condition with zileuton, a 5-lipoxygenase inhibitor.
Methods: Retrospective review of 45 patients at a tertiary care center with diagnosis of AERD who underwent functional endoscopic sinus surgery (FESS) with at least 6 months of pre- and postoperative clinical data were included in the study. Zileuton cohort chosen based on intention-to-treat after initial FESS. Background data collected included patient demographics, surgery information, and zileuton initiation dates. Zileuton and control cohorts were followed for 2.8 and 2.4 years, respectively. Outcomes measured were rhinosinusitis disability index (RSDI) scores, antibiotics use, corticosteroid use, otolaryngology visits, and time to revision surgery.
Results: RSDI scores, antibiotics use, corticosteroid use, otolaryngology visits, and time to revision surgery had no statistically significant difference between cohorts. However, those taking zileuton tended to undergo fewer revision surgeries during the study.
Conclusion: Zileuton therapy for AERD patients shows no statistical benefit for rhinologic quality-of-life symptoms but may be useful in diminishing frequency of surgical intervention. In addition, pulmonary symptoms may be improved by treatment but were not assessed. Future study is warranted.
Keywords: aspirin-exacerbated respiratory disease; functional endoscopic sinus surgery; leukotriene; quality of life; questionnaire; revision surgery; rhinology; rhinosinusitis disability index; sinusitis; zileuton.