AERD (Aspirin-Exacerbated Respiratory Disease): Complete Guide to Symptoms, Diagnosis & Treatment

Aspirin-exacerbated respiratory disease (AERD) is a chronic inflammatory condition that affects the respiratory system. This complex disorder, also known as Samter’s triad or aspirin-induced asthma, presents unique challenges for those diagnosed with it. Understanding AERD is crucial for proper management and improved quality of life.

What is Aspirin-Exacerbated Respiratory Disease (AERD)?

AERD is a chronic medical condition characterized by three distinct features that typically occur together. This triad includes persistent asthma, recurring nasal polyps, and adverse respiratory reactions to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).

The condition typically develops in adulthood, with most people experiencing their first symptoms between the ages of 30 and 40. However, AERD can occasionally affect younger individuals and even children, though this is less common.

It’s important to note that while AERD involves asthma, only a small percentage of people with asthma will develop this specific condition. The combination of all three features is what distinguishes AERD from other respiratory conditions.

The Three Key Features of AERD

Chronic Asthma

People with AERD experience persistent asthma that can range from mild to severe. This respiratory condition causes inflammation and narrowing of the airways, leading to difficulty breathing, wheezing, and chest tightness. The asthma associated with AERD often becomes more difficult to control over time and may not respond as well to standard asthma treatments.

Recurring Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths that develop on the lining of the nasal passages or sinuses. In people with AERD, these polyps tend to recur frequently, even after surgical removal. The polyps can cause chronic sinus problems, including congestion, reduced sense of smell or taste, facial pressure, and difficulty breathing through the nose.

Sensitivity to Aspirin and NSAIDs

The third characteristic feature of AERD is an adverse reaction to aspirin and other NSAIDs. These medications include common over-the-counter pain relievers and anti-inflammatory drugs. It’s crucial to be aware that aspirin and NSAIDs may be ingredients in various cold medicines, pain relievers, and other pharmaceutical products.

Recognizing AERD Symptoms

The symptoms of AERD can vary in severity from person to person. Common symptoms include:

• Persistent nasal congestion and sinus pressure
• Difficulty breathing through the nose
• Reduced or complete loss of sense of smell
• Wheezing and shortness of breath
• Chronic coughing
• Chest tightness
• Frequent sinus infections
• Facial pain or pressure
• Post-nasal drip

What Happens When People with AERD Take Aspirin or NSAIDs?

When individuals with AERD take aspirin or NSAIDs, they typically experience a sudden onset of respiratory symptoms that can be severe. These reactions usually begin within 30 minutes to 3 hours after taking the medication.

Symptoms of an AERD reaction may include:

• Sudden difficulty breathing or worsening asthma symptoms
• Severe wheezing
• Intense nasal congestion
• Runny nose with clear discharge
• Sneezing attacks
• Coughing fits
• Flushing of the face or neck
• Eye redness and tearing

Interestingly, some people with AERD also experience similar respiratory reactions when consuming alcohol, particularly beer and wine. This occurs because alcohol can trigger the same inflammatory pathways in the body.

Understanding the Causes of AERD

The exact cause of AERD remains unclear, and researchers continue to investigate the underlying mechanisms of this condition. What is known is that AERD is not an allergic reaction, despite the respiratory symptoms it produces.

Current research suggests that AERD involves an abnormality in how the body produces and regulates certain inflammatory chemicals called leukotrienes. When people with AERD take aspirin or NSAIDs, these medications interfere with the body’s inflammatory pathways, leading to an overproduction of leukotrienes. This excess of leukotrienes causes inflammation in the respiratory tract, resulting in the characteristic symptoms.

Important facts about AERD causes:

• AERD is not caused by taking aspirin or NSAIDs, but these medications trigger symptoms in people who have the condition
• There is no conclusive evidence that AERD is genetic or inherited
• The condition is not an allergic response
• Environmental factors may play a role in its development

How is AERD Diagnosed?

Diagnosing AERD can be challenging because there is no single definitive test for the condition. Healthcare providers typically use a combination of medical history, physical examination, and diagnostic tests to reach a diagnosis.

Medical History and Physical Examination

Your healthcare provider will ask detailed questions about your symptoms, including when they started, what triggers them, and whether you’ve noticed reactions to aspirin or NSAIDs. They’ll also perform a physical examination, including looking inside your nose for signs of nasal polyps.

Diagnostic Tests

Several tests can support an AERD diagnosis:

• Blood tests: These can check for elevated levels of eosinophils, a type of white blood cell often increased in people with AERD
• Urine tests: These can measure levels of leukotrienes, inflammatory chemicals that are typically elevated in AERD
• Smell tests: Since AERD often affects the sense of smell, specialized tests can assess this function
• Nasal endoscopy: A thin, flexible tube with a camera allows doctors to examine the nasal passages and identify polyps
• CT scans: These imaging tests can reveal the extent of nasal polyps and sinus inflammation
• Pulmonary function tests: These assess how well your lungs are working and the severity of asthma

Aspirin Challenge (Desensitization Testing)

When it’s unclear whether a person has sensitivity to aspirin or NSAIDs, healthcare providers may recommend an aspirin challenge. This supervised medical procedure involves administering gradually increasing doses of aspirin in a controlled clinical setting with emergency equipment available. The test is performed only by experienced medical professionals who follow strict safety protocols.

Treatment Options for AERD

While there is currently no cure for AERD, various treatment approaches can help manage symptoms and improve quality of life. Most people with AERD benefit from a combination of treatment strategies tailored to their individual needs.

Avoiding Trigger Medications

The first line of management involves avoiding aspirin and NSAIDs unless specifically directed otherwise by your healthcare provider. It’s essential to:

• Read medication labels carefully
• Inform all healthcare providers about your AERD diagnosis
• Be aware of hidden sources of NSAIDs in over-the-counter products
• Consider wearing a medical alert bracelet

Medication Management

Your healthcare provider may recommend various medications to control asthma and nasal symptoms. It’s crucial to consult with your doctor before starting any new medication, as they can prescribe the most appropriate treatments for your specific situation. Never start or stop medications without professional medical guidance.

Surgical Intervention

Surgery to remove nasal polyps may be recommended when polyps cause significant breathing problems or don’t respond to other treatments. However, it’s important to understand that polyps frequently recur in people with AERD, and surgery may need to be repeated over time.

Aspirin Desensitization Therapy

For some people with AERD, a procedure called aspirin desensitization may be beneficial. This specialized treatment is performed in a medical facility under close supervision. During the procedure, gradually increasing doses of aspirin are administered over approximately two days. After successful desensitization, patients continue taking a daily aspirin dose.

Potential benefits of aspirin desensitization include:

• Improved asthma control
• Reduced need for oral corticosteroids
• Slower regrowth of nasal polyps
• Decreased sinus symptoms
• Better quality of life

However, this treatment isn’t suitable for everyone and requires commitment to daily aspirin therapy. Discuss with your healthcare provider whether this option is appropriate for your situation.

Biologic Therapies

Advanced treatment options include biologic medications, which are engineered proteins that target specific inflammatory pathways in the body. Your doctor can determine if you’re a candidate for these therapies based on your symptom severity and response to other treatments.

Living with AERD: Practical Tips

Managing AERD requires ongoing attention and lifestyle adjustments. Here are some strategies to help you live better with this condition:

Create an Action Plan

Work with your healthcare team to develop a comprehensive management plan that includes:

• A list of medications to avoid
• Emergency contact information
• Steps to take if symptoms worsen
• Regular follow-up appointment schedules

Environmental Modifications

Reduce exposure to respiratory irritants by:

• Using air purifiers in your home
• Avoiding tobacco smoke and strong fragrances
• Keeping your living space clean and dust-free
• Using a humidifier to maintain optimal humidity levels

Monitor Your Symptoms

Keep a symptom diary to track:

• Daily symptom severity
• Potential triggers
• Medication effectiveness
• Changes in your sense of smell

Maintain Regular Medical Care

Schedule regular appointments with your healthcare providers, which may include:

• Allergist or immunologist
• Pulmonologist
• Ear, nose, and throat (ENT) specialist
• Primary care physician

The Importance of Patient Education

Understanding AERD empowers you to take an active role in managing your condition. Stay informed about:

• New research and treatment developments
• Medications to avoid
• Alternative pain management options
• Support resources and patient communities

When to Seek Emergency Care

Certain symptoms require immediate medical attention. Seek emergency care if you experience:

• Severe difficulty breathing
• Rapid worsening of asthma symptoms
• Signs of anaphylaxis (severe allergic reaction)
• Chest pain
• Blue lips or fingernails
• Extreme dizziness or confusion

Research and Future Directions

Ongoing research continues to improve our understanding of AERD. Scientists are investigating:

• The genetic factors that may contribute to AERD
• New therapeutic targets for treatment
• Better diagnostic tools
• Ways to prevent disease progression
• Quality of life improvements for patients

Conclusion

AERD is a complex respiratory condition that requires comprehensive management and ongoing medical care. While there is currently no cure, various treatment options can effectively control symptoms and improve quality of life. If you suspect you may have AERD or have been diagnosed with this condition, work closely with your healthcare team to develop a personalized treatment plan. With proper management, most people with AERD can lead active, fulfilling lives.

Remember that everyone’s experience with AERD is unique, and what works for one person may not work for another. Be patient with the treatment process, stay informed, and maintain open communication with your healthcare providers. Your active participation in your care is essential for achieving the best possible outcomes.

Sources:

• Mayo Clinic
• American Academy of Allergy, Asthma & Immunology
• American College of Allergy, Asthma & Immunology
• American Lung Association
• National Center for Biotechnology Information