Aspirin Exacerbated Respiratory Disease

This combination of conditions is sometimes also referred to as Samter’s Triad. These medical conditions are asthma, aspirin sensitivity, and sinusitis with recurring nasal polyps. This disease typically presents with rapid onset as a respiratory reaction to taking an NSAID during adulthood.

• Approximately one out of every ten asthma patients and one out of every three patients with asthma and nasal polyps will be diagnosed with AERDs.
• This will be determined based on their clinical history and confirmation of an aspirin sensitivity.

The cause of Aspirin exacerbated respiratory disease is still being researched and many questions still remain, especially because the majority of individuals with AERD don’t experience an aspirin sensitivity until adulthood. However, the most widely accepted explanation has to do with the arachidonic acid cascade. When this cascade malfunctions, the body will produce an abnormal number of leukotrienes. In turn, these leukotrienes will alter the body’s inflammatory response.

Since inflammation is involved in asthma, polyp formation, sinusitis, and allergic responses, this would explain the co-occurrence of these medical conditions. Adding to the feasibility of this explanation is the fact the consumption of aspirin blocks the body’s production of prostaglandin, which only worsens the level of leukotrienes resulting in an allergy-type response.

It is likely that an AERD patient will start out with the symptoms of either chronic sinusitis or asthma, or both. The patients who first have chronic sinusitis will likely report nasal congestion, sinus headaches, facial pain around their nasal cavities, cough, nasal polyps, and sneezing. In general, sinusitis is a very common ailment, which may mean that it takes more than a year in order for the physician to determine that is in fact a chronic condition rather than recurring acute sinusitis.

For the patients who first experience asthma, the symptoms may be mild symptoms such as a cough, frequent respiratory infections, rapid breathing, breathing through the mouth, and throat irritation. The patient could also experience tightening of the chest, difficulty breathing, wheezing, and full asthma attacks. However, the patient will likely not be diagnosed with AERD until they have a reaction to aspirin. These reactions may begin mildly as sinus symptoms but can be more severe, including full asthma attack, severe hives, or anaphylaxis.

Since aspirin exacerbated respiratory disease is actually a compilation of many diseases, it is possible that the patient will need several treatment plans, some of which may be quite aggressive. It is always important to maintain an effective asthma treatment, which will probably combine the use of daily and emergency medication. Additionally, a steroid regimen will help control the sinus symptoms and polyps. However, many people need to have these polyps surgically removed and this surgery often has to be repeated. Patients with extreme sensitivities to aspirin may be recommended to be desensitized. This must be done under physician supervision and involves exposing the patient to aspirin in increasing dosages. While there is risk with this process, it does often reduce the sinus and asthma symptoms.