Aspirin-exacerbated respiratory disease: characteristics and management strategies

Abstract

Aspirin-exacerbated respiratory disease is a clinical entity comprising chronic rhinosinusitis with nasal polyposis, asthma and intolerance to COX-1 inhibiting drugs. The pathogenesis is not completely understood at this point, but abnormal arachidonic acid metabolism is a key feature in this syndrome. The diagnosis is confirmed only by direct drug challenge. Aspirin desensitization followed by daily aspirin therapy is a useful treatment option in these patients. In this review article are discussed the important characteristics and treatment of aspirin-exacerbated respiratory disease.

Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

“…Therefore, challenges with NSAID are rarely performed for diagnostic purposes outside research units [2][3][4]6].…”

“…A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) can only be made based on a single-blind placebo-controlled oral challenge (SBPCOC) with aspirin or another nonsteroidal anti-inflammatory drug (NSAID) carried out in patients with clinically suspected AERD [1][2][3][4]. However, SBPCOC is a time-consuming approach that can take at least 2 days to perform and result in severe reactions (mainly asthma exacerbations, laryngospasm, and even systemic symptoms in some cases).…”

Prevention of Malpractice in the Field of Health, as the Other Type of Prevention

“…• Prescribing aspirin for children and teenagers <18 years of age in influenza • Administration aspirin in asthmatic patients and chronic rhinosinusitis with nasal polyposis which may lead to exacerbation of respiratory disease [36].…”

Evidence and evidence gaps in therapies of nasal obstruction and rhinosinusitis

“…Because the recurrence rates after FESS are very high in aspirin-exacerbated respiratory disease, this therapy must be complemented using special pharmaceutic therapies. Aspirin desensitisation in the meantime is acknowledged as the standard therapy for such patients and is recommended in the guideline on rhinosinusitis [30] and other publications [116], [167]. In this therapy, the application of ASA induces tolerance to NSAIDs [168].…”