Aspirin Exacerbated Respiratory Disease

Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter's Triad or Aspirin-Induced Asthma, is a chronic medical condition characterized by the triad of asthma, nasal polyps, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit the Cyclooxygenase-1 (COX-1) enzyme. This condition is a type of drug hypersensitivity affecting various bodily systems, primarily the respiratory system. It is considered a unique and severe form of asthma that is often difficult to manage due to its association with sinus disease and NSAID sensitivity.

Symptoms and Diagnosis

The hallmark symptoms of AERD include asthma, chronic sinusitis with nasal polyps, and a history of adverse reactions to aspirin or other NSAIDs. These reactions can range from mild rhinorrhea (runny nose) to severe respiratory distress following the ingestion of NSAIDs. Diagnosis is primarily clinical but can be confirmed with an aspirin challenge test, which must be conducted under strict medical supervision due to the risk of severe reactions.

Pathophysiology

The exact pathophysiological mechanism of AERD is not fully understood, but it is believed to involve the dysregulation of arachidonic acid metabolism. In individuals with AERD, the inhibition of COX-1 by NSAIDs leads to an overproduction of leukotrienes, potent inflammatory mediators, which contribute to the symptoms of asthma and sinusitis.

Treatment

Management of AERD involves a combination of strategies aimed at controlling asthma and sinus symptoms, as well as avoiding NSAID exposure. Treatment may include the use of glucocorticoids to reduce inflammation, leukotriene receptor antagonists (LTRAs) to block the action of leukotrienes, and desensitization to aspirin, which can help reduce sensitivity to NSAIDs and improve respiratory symptoms. Surgical intervention may be necessary to remove nasal polyps if they are causing significant obstruction or contributing to sinus infections.

Epidemiology

AERD affects approximately 0.3-0.9% of the general population and up to 7% of asthmatic patients. It typically presents in adulthood, with a mean age of onset between 30 and 40 years. There is no clear gender predilection.

Prevention and Prognosis

There is no known prevention for AERD. The prognosis varies; while the condition can significantly impact quality of life due to chronic respiratory symptoms and the need for ongoing medication, appropriate management and treatment can lead to substantial improvement in symptoms and overall health.

See Also

• Asthma
• Nasal polyps
• Drug hypersensitivity
• Non-steroidal anti-inflammatory drugs
• Cyclooxygenase inhibitors