aspirin-induced respiratory disease

Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad, is a chronic medical condition that affects the respiratory system. It is characterized by three main features:

• Asthma: AERD patients often experience asthma symptoms, which can range from mild to severe.
• Nasal polyps: Nasal polyps are growths in the nasal passages that can cause congestion, discharge, and difficulty breathing through the nose.
• Aspirin intolerance: AERD patients are highly sensitive to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), which can trigger severe respiratory symptoms, including asthma attacks.

This condition is not an allergic reaction, but rather a non-allergic hypersensitivity that produces severe respiratory symptoms. The exact cause of AERD is still unknown, but it is believed to be related to the inhibition of cyclooxygenase-1 (COX-1), an enzyme involved in the production of prostaglandins.

Symptoms of AERD can include:

• Congested nose and nasal discharge
• Asthma attacks
• Sinus pressure and pain
• Difficulty breathing through the nose

AERD is a chronic condition that requires ongoing management to prevent symptoms from flaring up. Treatment options may include medications, such as corticosteroids and bronchodilators, as well as lifestyle changes, like avoiding aspirin and other NSAIDs.

References:

• [1] Stevenson & Szczeklik (1922) - Original definition of AERD
• [2] Widal et al. (1922) - Early description of AERD symptoms
• [3] Gilbert (1902) - First noted aspirin-induced asthma attack
• [4] Hirschberg (1902) - Described adverse reactions to aspirin in Germany

Aspirin-induced respiratory disease (AIRD) is a condition characterized by severe respiratory symptoms triggered by the ingestion of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). The signs and symptoms of AIRD can vary in severity and may include:

• Respiratory symptoms: Coughing, wheezing, chest tightness, shortness of breath, and asthma-like attacks [1][2]
• Upper respiratory symptoms: Nasal congestion, runny nose, watery eyes, and facial flushing [3][4]
• Gastrointestinal symptoms: Nausea, vomiting, abdominal cramping pain, and diarrhea [5][6]
• Other symptoms: Unusual fatigue, dizziness, and in severe cases, anaphylaxis-like reactions [2][7]

It's essential to note that the symptoms of AIRD can be similar to those of other conditions, such as asthma or allergic rhinitis. However, the presence of gastrointestinal symptoms, particularly abdominal cramping pain, is a key indicator of aspirin-induced respiratory disease.

In some cases, people with AIRD may experience systemic reactions, which can include symptoms like fever, chills, and muscle weakness [3]. If you suspect that you or someone else has AIRD, it's crucial to seek medical attention immediately.

Aspirin-exacerbated respiratory disease (AERD) diagnosis can be challenging, and there isn't a specific test to confirm the condition. However, several diagnostic methods can help identify AERD.

• Clinical Diagnosis: The diagnosis of AERD is primarily clinical, meaning that it's based on a patient's medical history, symptoms, and physical examination. Many patients with AERD present with all three components: asthma, nasal polyps, and aspirin sensitivity (1). A healthcare professional can reliably diagnose AERD by history in many cases (8).
• Aspirin Challenge Procedure: The oral aspirin challenge is considered the gold standard for confirming AERD diagnosis. However, this procedure may not be necessary for all patients, as a clinical diagnosis based on history and symptoms can be sufficient (2).
• Lab Tests: While there isn't a specific test to diagnose AERD, lab tests can help identify the underlying cause of a patient's illness. For example, a blood test can check for higher than normal levels of certain substances that may indicate an allergic reaction or other conditions (3).

It's essential to note that diagnosing AERD requires expertise and knowledge of the condition. Specialists at centers like the Penn AERD Center can provide accurate diagnoses in patients presenting with asthma, nasal polyps, and aspirin sensitivity (5).

References:

1. HS Chang et al. (2011) - Oral aspirin challenge is the gold standard to confirm the diagnosis.
2. R Haque et al. (2021) - Diagnosis is confirmed after an aspirin challenge procedure, yet many patients present with all components and can reliably be diagnosed by history.
3. There is no special test to find AERD. There are lab tests that can help in finding the cause of your illness.
4. Diagnosis The diagnosis of AERD is a clinical one, meaning that there is no one specific test or blood result that alone can be used to diagnose the disease.
5. With proper knowledge of AERD and the expertise of the specialists at the Penn AERD Center, diagnosing AERD in patients who present with asthma, nasal polyps ...
6. by SAA Comhair · 2018 · Cited by 29 — Background. Aspirin-exacerbated respiratory disease (AERD) is a distinct eosinophilic phenotype of severe asthma with accompanying chronic ...

Aspirin-exacerbated respiratory disease (AERD), also known as Samter's Triad, is a condition characterized by asthma, recurring nasal polyps, and sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). The treatment of AERD involves managing the symptoms of asthma and chronic rhinosinusitis with nasal polyps.

Treatment Options:

• Standard-of-care treatment: This includes guideline-based treatment for asthma and sinus disease, which may involve medications such as oral steroids, bronchodilators, and corticosteroid sprays.
• Aspirin desensitization: This is a process where patients are gradually exposed to small amounts of aspirin to build up tolerance. Once desensitized, patients can take daily aspirin therapy to help manage their symptoms (1).
• Leukotriene modification: This involves using medications that block the action of leukotrienes, which are chemical mediators involved in inflammation and airway constriction.
• Daily aspirin therapy: After aspirin desensitization, some patients may benefit from taking daily aspirin to help manage their symptoms (7).
• Dupilumab therapy: This is a biologic medication that has been shown to be effective in treating AERD by reducing inflammation and improving symptoms (7).

Pharmacotherapies:

• Oral steroid
• Lipoxygenase inhibitor drugs
• CysLT receptor inhibitor drugs

These medications can provide some relief for patients with AERD, but they may not address the underlying condition. Aspirin desensitization followed by daily aspirin therapy has been shown to be the most effective treatment option (2).

References:

(1) Management includes guideline-based treatment of asthma and sinus disease, avoidance of COX-1 inhibitors, and for some patients aspirin desensitization followed ...

(2) After many years of research, numerous studies have confirmed that a complete sinus surgery followed by aspirin desensitization is the most effective treatment ...

(3) Pharmacotherapies include oral steroid, lipoxygenase inhibitor, and cysLT receptor inhibitor drugs, which can provide some relief for these patients.

(6) Treatment of AERD includes standard-of-care treatment for asthma and chronic rhinosinusitis with nasal polyps, leukotriene modification, aspirin ...

(7) Both daily aspirin therapy after aspirin desensitization, and dupilumab therapy, have been important treatments for patients with AERD, and further studies may ...

Aspirin-induced respiratory disease (AIRD) can be challenging to diagnose, and a differential diagnosis is essential to rule out other conditions that may present with similar symptoms. Here are some key points to consider:

• Chronic Rhinosinusitis with Nasal Polyps (CRSwNP): This condition often presents with chronic rhinosinusitis, nasal polyps, and asthma, which can be similar to AIRD. However, the presence of eosinophilic rhinosinusitis and a history of typical respiratory reactions to NSAIDs are more characteristic of AIRD [6][7].
• Asthma: Asthma is a common condition that can present with symptoms such as wheezing, coughing, and shortness of breath. However, the presence of nasal polyps and eosinophilic rhinosinusitis in patients with asthma may suggest AIRD [3][4].
• Eosinophilic Rhinosinusitis: This is a condition characterized by an overabundance of eosinophils in the nasal passages and sinuses. It can present with symptoms such as chronic rhinosinusitis, nasal polyps, and asthma, which are similar to AIRD [6][7].
• Nonsteroidal Anti-Inflammatory Drug (NSAID)-Exacerbated Respiratory Disease (NERD/N-ERD): This is a condition that presents with respiratory symptoms after ingestion of NSAIDs. However, it does not typically involve the formation of nasal polyps or eosinophilic rhinosinusitis [5].
• Other Conditions: Other conditions such as allergic rhinitis, sinusitis, and gastroesophageal reflux disease (GERD) can also present with respiratory symptoms that may be similar to AIRD. However, a thorough medical history and physical examination are essential to rule out these conditions.

In summary, the differential diagnosis of aspirin-induced respiratory disease includes CRSwNP, asthma, eosinophilic rhinosinusitis, NERD/N-ERD, and other conditions such as allergic rhinitis, sinusitis, and GERD. A thorough medical history, physical examination, and diagnostic tests are essential to rule out these conditions and make an accurate diagnosis.

References: [1] RU Lee (2011) - Cited by 280 [2] TM Laidlaw (Cited by 7) [3] AERD, also called Samter's triad, has three features: asthma, recurring nasal polyps, and sensitivity to aspirin and drugs such as ibuprofen and naproxen. [4] R Haque (2021) - Cited by 19 [5] Aspirin-induced asthma, Samter's triad, Samter's syndrome, nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD/N-ERD). [6] JC Rodríguez-Jiménez (2018) - Cited by 70 [7] JC Rodríguez-Jiménez (2018) - Cited by 70