Aspirin exacerbated respiratory disease

Aspirin-Exacerbated Respiratory Disease (AERD)

Aspirin-Exacerbated Respiratory Disease (AERD), also known as Samter's Triad or aspirin-sensitive 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). This condition affects approximately 0.3-0.9% of the general population and up to 7% of asthmatic patients. AERD is more common in adults and is rarely diagnosed in children.

Symptoms

The symptoms of AERD typically include:

• Asthma: Wheezing, coughing, and difficulty breathing.
• Nasal polyps: Small, non-cancerous growths in the nasal passages or sinuses that can lead to congestion, loss of smell, and infections.
• Sensitivity to aspirin and NSAIDs: Reactions can range from mild to severe respiratory distress, nasal congestion, and skin rashes.

Pathophysiology

The exact cause of AERD is not fully understood, but it involves an abnormal response of the immune system. The condition is characterized by overproduction of cysteinyl leukotrienes, substances that contribute to inflammation and allergic reactions. When patients with AERD consume aspirin or other NSAIDs, their bodies produce an excessive amount of leukotrienes, leading to the worsening of symptoms.

Diagnosis

Diagnosis of AERD is based on a combination of patient history, clinical symptoms, and the results of aspirin challenge tests. These tests involve administering aspirin under medical supervision to observe for adverse reactions. Other diagnostic tools include spirometry to assess lung function and imaging studies, such as CT scans, to detect nasal polyps.

Treatment

Treatment of AERD focuses on managing symptoms and preventing severe reactions. Strategies include:

• Avoidance of aspirin and other NSAIDs.
• Use of alternative pain relievers, such as acetaminophen.
• Treatment of asthma and nasal polyps with medications, including corticosteroids and leukotriene receptor antagonists.
• Aspirin desensitization: A process in which patients are gradually given increasing doses of aspirin under medical supervision to build tolerance.

Prognosis

With appropriate management, individuals with AERD can lead normal, active lives. However, the condition requires ongoing treatment and monitoring to control symptoms and prevent complications.

Epidemiology

AERD is more commonly diagnosed in adults, with a peak incidence in the third to fourth decade of life. It affects both men and women, although some studies suggest a slightly higher prevalence in women.

See Also

• Asthma
• Nasal polyps
• Non-steroidal anti-inflammatory drug
• Leukotriene antagonist