***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The daily dose of aspirin in desensitization in aspirin‐sensitive asthmatics with nasal polyps is still a matter of debate INTRODUCTION Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control , with frequent recurrences . We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic , aspirin-intolerant patients , when used in addition to routine therapy . PATIENTS AND METHODS Thirteen patients with asthma and intolerance to aspirin were recruited . All but one had undergone numerous polypectomies and were uncontrolled on st and ard therapy with intranasal  corticosteroids , leukotriene receptor antagonists and nasal douching . Aspirin treatment involved one drop ( 100 microl ) of 30 mg/ml lysine-aspirin solution to each nostril , initially daily , increased every two or three days up to a maximal of 18 drops ( 54 mg lysine-aspirin ) a day . Nasal symptoms , nitric oxide level , nasal inspiratory peak flow rate , peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later . We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration ( during which time other therapies had been identical ) . RESULTS Nasal blockage symptoms tended to decrease ; other nasal symptoms were unchanged . Significant changes were seen in nasal inspiratory peak flow rate ( 103.3 + /- 18.9 and 140.0 + /- 16.7 l/min before and after aspirin , respectively ; p = 0.014 ) , but not in peak expiratory flow rate ( 438.7 + /- 33.4 and 440.0 + /- 28.4 l/min before and after aspirin , respectively ; p = 0.700 ) . Nasal nitric oxide levels rose significantly ( in both sides , p = 0.028 ) . Expired chest nitric oxide levels did not change . Nasal polyp scores on nasendoscopic examination were significantly reduced ( right side , p = 0.027 ; left side , p = 0.018 ) . Compared with the preceding three months , adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume ( right side , p = 0.031 ; left side , p = 0.016 ) . CONCLUSION This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients , without any adverse affect on concomitant asthma . This was a preliminary study and should be followed by a placebo-controlled , double-blind trial BACKGROUND Patients with aspirin-sensitive rhinosinusitis , which is frequently associated with intrinsic bronchial asthma , can be desensitized by long-term treatment with oral aspirin . The exact mechanisms of this desensitization remain obscure , but modulations of the eicosanoid pathway occur and can be monitored with the help of a practicable in vitro assay on mixed leukocyte cultures . OBJECTIVE To monitor the effect of low-dose aspirin desensitization therapy , 100 mg/d , objective ly by an in vitro assay . DESIGN In a prospect i ve study , 30 patients with aspirin intolerance , who were treated following a desensitization protocol with a dose of oral aspirin of only 100 mg/d  were followed up for 1 year and reassessed every 3 months clinical ly and in vitro . RESULTS Twenty-five patients showed a normalization of in vitro eicosanoid levels during this period , 4 showed some improvement , and 1 showed no therapeutic effect on eicosanoid release . Clinical follow-up revealed a low recurrence rate of nasal polyposis , with recurrent disease only in 4 individuals who also showed no normalization of eicosanoid release levels . Furthermore , a reduction of the average incidence of purulent episodes of sinusitis was seen after 1 year . Of 12 patients with asthma , 9 experienced marked improvement in pulmonary function . Of 16 individuals with a marked impairment of nasal breathing , 14 felt an increase of nasal patency , and 7 of 11 patients with pretreatment hyposmia had an improved sense of smell after 1 year . CONCLUSIONS Desensitization therapy in patients with aspirin-sensitive rhinosinusitis can be successfully performed with low oral doses of aspirin , and the individual course throughout the desensitization can be monitored with the help of an in vitro analysis of eicosanoid release from mixed leukocyte cultures OBJECTIVES /HYPOTHESIS Evidence is lacking to guide the postoperative management of Samter 's triad patients with chronic rhinosinusitis with polyposis ( CRSwP ) undergoing endoscopic sinus surgery ( ESS ) . The purpose of this study was to compare three different st and ardized medication regimens prescribed to these patients after ESS . STUDY DESIGN Three-arm , r and omized , double-blinded , controlled trial . METHODS Patients with Samter 's triad undergoing ESS were postoperatively r and omized into three medication regimens , those being saline irrigation alone ( control group A ) , saline irrigation plus separate budesonide nasal spray ( group B ) , and saline irrigation mixed with budesonide nasal spray ( group C ) . Outcome measures were Sino-Nasal Outcome Test scores , Lund-Mackay computed tomography scores , and Lund-Kennedy endoscopic scores taken at preoperative baseline , and then at 6 months and 1 year postoperatively . Side effect profiles were also measured ( adrenocorticotropic hormone blood level ranges and intraocular pressure at the same interval points ) . Analysis of variance and χ(2 ) analyses were conducted using a Bonferroni correction method and routine descriptive statistics . Inter- and intragroup comparisons were made . RESULTS Sixty subjects were recruited . All groups were equivalent at baseline in all outcomes . All intragroup analyses showed statistically and clinical ly significant improvement in disease status as compared to baseline ( P < .0167 ) , with a sustained but lessened improvement at 1 year . However , no statistically or clinical ly significant differences were observed between groups at any time point ( P > .05 ) . There was no treatment effect noted . CONCLUSIONS In this study , nasal steroids did not confer any additional benefit over saline alone as post-ESS care for the Samter 's triad CRSwP patient population OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Aspirin desensitization followed by daily aspirin therapy is effective add-on treatment for patients with aspirin-exacerbated respiratory disease . Prior studies used 650 mg of aspirin twice daily , but studies at lower dosages were inconclusive . OBJECTIVE We sought to determine the optimal daily dosage of aspirin treatment . METHODS We studied 137 patients who had undergone successful aspirin desensitization and r and omized them into 2 groups , 650 mg twice daily versus 325 mg twice daily . After 1 month , patients either increased or decreased their dosage based on their symptom control and continued that dosage for the remainder of the year . RESULTS Patients taking either 650 mg twice daily or 325 mg twice daily showed significant improvements in number of sinus infections , sinus operations , and hospitalizations for asthma ( all P < .0001 ) . Anosmia , nasal/sinus symptoms , and asthma symptoms also improved in both groups ( all P < .03 ) . Systemic corticosteroid dosages decreased by 3- and 4-fold in the 325 mg twice daily and 650 mg twice daily groups , respectively . Of the 137 patients , 32 had adverse effects  from or discontinued  aspirin therapy : 14 ( 44 % ) of 32 from the group r and omized to taking 650 mg twice daily and 18 ( 56 % ) of 32 from the group r and omized to 325 mg twice daily . The most common adverse effect was dyspepsia . CONCLUSION Both dosages were efficacious , and side effects occurred in both groups at similar frequencies . Some patients initially taking 325 mg twice daily required an increase to 650 mg twice daily for optimal symptom control . CLINICAL IMPLICATION S We recommend that patients begin daily aspirin therapy with 650 mg twice daily and subsequently decrease to the lowest effective dosage ( usually 325 mg twice daily ) BACKGROUND Aspirin (ASA)-exacerbated respiratory disease ( AERD ) is characterized by aggressive inflammation of the respiratory tract and often requires topical and /or systemic corticosteroids to maintain partial control of this disease . Previous studies have revealed that ASA desensitization and subsequent treatment with ASA is associated with clinical improvement in AERD . OBJECTIVE The aim of the present study was to determine the effect of daily ASA treatment for the first 4 weeks after ASA desensitization . METHODS Thirty-eight patients underwent ASA oral challenge followed by ASA desensitization and daily ASA therapy .  Changes in nasal and asthma symptoms , combined with changes in oral prednisone , were recorded daily during 4 weeks before and after desensitization . Severity of symptoms ranged from a scale of 1 to 5 ( 1 = asymptomatic and 5 = most severe symptoms ) . For statistical analyses the sum of nasal symptoms and asthma symptoms was calculated . Olfactory scores were also analyzed . RESULTS Nasal and asthma symptom scores , as well as olfactory scores , improved significantly ( P < 0.0001 ) . For the 15 patients taking prednisone  , their mean doses decreased from 10.7 to 5.9 mg daily ( P = 0.0003 ) . CONCLUSIONS Our study suggests that ASA desensitization treatment is effective during the first 4 weeks of daily treatment with ASA Nasal polyposis is a multifactorial disease with a complex and still not completely understood pathogenesis . In more than one third of cases it is associated with intolerance to acetylsalicylic acid ( aspirin , ASA ) or to other non-steroidal anti-inflammatory drugs (NSAIDs).1 In as many as 20 % of cases nasal polyposis is also associated with the presence of bronchial asthma and /or rhinitis , configuring the so-called ASA triad or aspirin disease.2 Nasal polyps may benefit from medical treatment ( corticosteroids ) and surgery,3 but they frequently relapse soon after surgery4 - 9 with significant morbidity and high social and medical costs . Unfortunately , the effect of treatment with steroids is also often temporary.3 10 - 16 In the last two decades it has been observed that , in aspirin sensitive patients , oral aspirin desensitisation ( followed by long term aspirin treatment ) often results in an improvement in the clinical course of nasal polyposis.17 - 21 We have shown that aspirin sensitive patients with nasal polyposis have a higher rate of positive nasal provocation tests ( rhinomanometric measure of nasal airflow reduction after exposure to the drug ) with lysine-acetylsalicylate ( LAS ) than aspirin sensitive patients without nasal polyps.22 - 24 Moreover , LAS has been found to have an in vitro non-specific antiproliferative , dose dependent effect on the growth of fib 
    Output:
    
Overall , most studies reported a significant improvement in symptom scores , decrease in corticosteroid use , and decrease in revision surgery .
Unlike traditional treatments for nasal polyposis , aspirin desensitization targets AERD etiology rather than phenotype and can be an effective therapeutic option .