aspirinexacerbated

Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad, is a chronic inflammatory condition defined by the combination of asthma, chronic rhinosinusitis with nasal polyps, and sensitivity to aspirin and other NSAIDs that inhibit COX-1.

Pathophysiology involves dysregulated arachidonic acid metabolism: COX-1 inhibition reduces prostaglandin E2, while increased leukotriene production and eosinophilic inflammation drive bronchoconstriction and polyp growth.

Clinical features include onset typically in adolescence or adulthood; symptoms include acute bronchospasm after NSAID ingestion, nasal congestion, hyposmia or anosmia, rhinorrhea, and persistent asthma.

Diagnosis is based on history and clinical suspicion in patients with asthma and chronic rhinosinusitis with nasal polyps who report adverse reactions to aspirin or other NSAIDs; confirmation may involve an aspirin challenge under supervision or desensitization.

Management emphasizes avoidance of COX-1–inhibiting NSAIDs; alternatives include acetaminophen or certain COX-2 inhibitors where tolerated, as well as treatment of asthma and sinus disease with intranasal steroids and appropriate systemic therapy; leukotriene modifiers may help; aspirin desensitization can be considered in selected patients followed by ongoing daily aspirin, and surgical polyp removal may be needed; biologics targeting type 2 inflammation (such as dupilumab or anti-IL-5 agents) may benefit severe disease.

Prognosis and research: With appropriate management, symptoms can be controlled; AERD is a chronic condition with potential for recurrent polyps; ongoing research aims to clarify pathophysiology and optimize targeted therapies.