Aspirin Exacerbated Respiratory Disease

Triggered by exposure to aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs), AERD can produce reactions that range from mild nasal congestion to serious symptoms that may include respiratory issues and chest tightness or shortness of breath.

Symptoms may develop anywhere from 30 minutes to 3 hours after taking aspirin or a similar type of medication.

A subgroup of asthma, aspirin sensitive respiratory disease doesn’t have a known cause. AERD may also affect patients with sinus disease or issues with nasal polyps. Risk factors for developing the condition include being sensitive to anti-inflammatory medications or aspirin. Other than exposure to NSAIDs, possible triggers include:

• Being around indoor or outdoor air pollution
• Weather-related changes
• Viral infections like the common cold

Patients with asthma or nasal congestion who develop AERD may notice that NSAIDs that previously managed symptoms are no longer as effective. In some instances, sinus infections may return frequently or the sense of smell may be affected. Other individuals with a condition also referred to as Samter’s Triad might have reactions to aspirin or NSAIDs that include:

• Sinus-related discomfort
• Skin flushing or rashes
• Headaches felt in the front of the head
• Coughing and/or wheezing
• Abdominal discomfort

It’s usually an observation or review of symptoms that suggests a patient may have AERD. The condition is not able to be diagnosed with a blood test. However, patients with nasal polyps may have elevated levels of an immune cell associated with inflammation that suggests they may also have AERD. In some cases, aspirin may be given to a patient under doctor supervision to observe the reaction.

For patients with severe symptoms, it may be advised to avoid NSAIDs. If this is the case, it may still be safe to take acetaminophen (Tylenol) as an alternative to aspirin for pain relief or headaches. Leukotriene inhibitors such as montelukast (Singulair) are sometimes helpful.

Another treatment option is aspirin desensitization. It’s a process involving small doses of aspirin that are progressively increased as the body’s immune system develops a tolerance to aspirin. There may be some initial adverse reactions as small doses of aspirin are administered, although patients are usually carefully monitored as dosages are increased to minimize risks. Successful desensitization may allow patients to:

• Safely take some other NSAIDs in controlled dosages
• Have fewer issues with nasal polyps or regrowth
• Experience improvements with taste and smell
• Have less dependence on medication specifically for AERD symptoms
• Improve asthma control

Having aspirin sensitive respiratory disease doesn’t necessarily mean avoiding NSAIDs altogether. Even so, having to be mindful of taking such medications can be make it difficult to treat colds and certain preexisting conditions like heart disease. This is usually when desensitization is suggested. If nasal polyps are a contributing factor to Samter’s Triad, surgery may be recommended. Underlying sinusitis and asthma symptoms may respond well to corticosteroids.