Aspirin-Exacerbated Respiratory Disease: How to Diagnose and Treat AERD

What Is Aspirin-Exacerbated Respiratory Disease?

AERD is a chronic inflammatory condition affecting the airways, triggered by aspirin and other NSAIDs, and characterized by three key features: asthma, recurring nasal polyps, and chronic sinusitis. Also known as Samter’s Triad, it doesn’t show up in kids-it starts in adulthood, usually between ages 20 and 50. About 7% of adults with asthma have it, and if you have nasal polyps too, that number jumps to 14%. Women are slightly more likely to be affected, making up about 60% of cases.

Unlike a simple allergy, AERD isn’t caused by IgE antibodies. Instead, it’s a metabolic mess. When you take aspirin or ibuprofen, your body overproduces inflammatory chemicals called cysteinyl leukotrienes. These flood your sinuses and lungs, causing swelling, mucus buildup, wheezing, and nasal congestion. The result? You can’t breathe well, you lose your sense of smell, and you end up needing surgery over and over again.

How Do You Know If You Have AERD?

There’s no single blood test or scan that confirms AERD. Diagnosis comes down to three things: your symptoms, your history, and sometimes, a controlled challenge.

• Asthma-you’ve had it for years, maybe since your 20s, and it’s gotten worse over time. It doesn’t respond well to standard inhalers alone.
• Nasal polyps-you’ve had them for a while, and they keep coming back even after surgery. Your nose is always stuffed, you snore, and you can’t smell your coffee or your partner’s perfume.
• Reaction to NSAIDs-within an hour of taking aspirin, ibuprofen, naproxen, or even some cold medicines, you get wheezing, nasal congestion, or even a full asthma attack.

If your story matches this pattern, your doctor will suspect AERD. But if you’re not sure whether a past reaction was real-or if you’ve avoided NSAIDs for so long you can’t remember-you might need a supervised aspirin challenge.

This isn’t something you do at home. It’s done in a hospital or allergy clinic with doctors ready to treat a severe reaction. You start with a tiny dose of aspirin-20 to 30 milligrams-and every 90 to 120 minutes, the dose doubles. You’re watched closely for breathing changes. If you react, they stop and treat you. If you don’t, they reach 325mg-the standard adult dose-and confirm you have AERD. About 98% of people who try this under supervision complete it safely.

What Happens If You Don’t Treat It?

Left alone, AERD gets worse. Nasal polyps grow back faster than you can get them removed. You’ll need repeat surgeries-sometimes every year. Your asthma gets harder to control. You’ll rely more on oral steroids, which cause weight gain, bone loss, and mood swings over time.

Many patients lose their sense of smell completely. A 2022 survey of 190 people with AERD found that 78% said nasal congestion made daily life unbearable. Nearly half had at least one sinus surgery within two years of diagnosis. Without proper management, your quality of life plummets.

First-Line Treatments: Medications That Help

Even before considering surgery or desensitization, you need strong medical control.

• Steroid sinus rinses-using a neti pot with 50-100mg of budesonide twice a day reduces polyp size by 30-40% in just eight weeks. This is often the most underused tool.
• Intranasal sprays-fluticasone (two sprays per nostril twice daily) improves nasal symptoms by 35% on the SNOT-22 scale after 12 weeks.
• Asthma inhalers-a combination of fluticasone and salmeterol (250/50μg, two puffs twice daily) boosts lung function by 15-20% in most patients.

These aren’t cures, but they keep things stable. Many people think avoiding NSAIDs is enough. It’s not. AERD keeps progressing even if you never take another aspirin.

Second-Line Options: Leukotriene Modifiers and Biologics

If steroids and rinses aren’t enough, you move up the ladder.

Zileuton blocks the enzyme that makes leukotrienes. Taken four times a day, it cuts urinary leukotriene E4 levels by 75% in two weeks. About 28% of users say it’s “extremely effective.” The downside? You need liver checks every few months.

Montelukast (Singulair) is easier-just one pill a day-but it’s less powerful. Only 15% of AERD patients report big benefits.

For the toughest cases, biologics are changing the game:

• Dupilumab (Dupixent)-injected every two weeks, it shrinks polyps by 55% and improves quality of life scores by 40% in 16 weeks. It’s now FDA-approved for nasal polyps, even without asthma.
• Mepolizumab (Nucala)-monthly shots that slash eosinophil counts by 85%. It cuts the need for future sinus surgeries by 57% over a year.

These drugs are expensive. If your income is under $50,000 a year, cost is often the biggest barrier. But many patients qualify for patient assistance programs.

Aspirin Desensitization: The Game-Changer

This is where things get powerful. If you’re a candidate, aspirin desensitization can transform your life.

The process starts with the same challenge used for diagnosis-but instead of stopping when you react, you keep going until you hit 325mg. Then, you start taking 650mg of aspirin every day, twice a day. It sounds crazy-how do you take the thing that makes you sick? But your body adapts. Over time, your airways stop reacting.

Studies show that after desensitization:

• Oral steroid use drops from 4.2 bursts per year to just 1.1.
• Nasal polyp recurrence after surgery falls from 85% to 35% within two years.
• Smell function improves dramatically-scores on smell tests jump from 12.4 to 23.7 out of 40.

One patient on a popular forum said, “I smelled my granddaughter’s birthday cake for the first time in 12 years.” That’s not hype-it’s science.

But there’s a catch: you have to take aspirin every day, no breaks. Miss two or three doses, and your body forgets it’s desensitized. You’ll need to go through the whole challenge again. About 68% of people who miss doses have to restart.

Side effects? Stomach upset happens in 22% of users. Taking aspirin with food helps. Some need a proton pump inhibitor like omeprazole to protect their stomach lining.

Surgery + Desensitization: The Gold Standard

Doctors who treat AERD agree: the best results come from combining surgery with daily aspirin.

Functional endoscopic sinus surgery (FESS) clears out polyps and opens your sinuses. Alone, it gives you 70-80% symptom relief-but 60-70% of people get polyps back within 18 months.

Add aspirin desensitization after surgery, and recurrence drops to 25-30% at two years. That’s a 65% reduction in polyp return compared to medical treatment alone.

Dr. Tanya Laidlaw from Brigham and Women’s Hospital says, “Complete sinus surgery followed by aspirin desensitization represents the gold standard.” It’s not just about breathing better-it’s about avoiding endless surgeries and steroid side effects.

Who Shouldn’t Try Desensitization?

It’s not for everyone. If you have:

• Severe heart disease or unstable angina
• Active peptic ulcers or a history of GI bleeding
• Difficulty remembering to take daily meds

Then it’s too risky. About 15% of people who might benefit are ruled out for safety reasons.

Also, if you’re not near a specialized center, it’s hard to access. There are only 35 AERD centers in the U.S. Most are in big cities. Rural patients often can’t get care within 100 miles.

What About Hidden NSAIDs?

Many patients don’t realize how many products contain aspirin or NSAIDs. Cold medicines, pain patches, topical gels, even some toothpaste and mouthwashes have them. Always check labels for:

• Aspirin
• Ibuprofen
• Naproxen
• Diclofenac
• Indomethacin

Some people think “NSAID-free” labels mean safe-but they don’t. Always ask your pharmacist or doctor if a product is okay. Reddit users on r/SamtersTriad swear by keeping a list of safe OTC meds in their wallet.

Future Treatments on the Horizon

The field is moving fast. A new drug called MN-001 (tipelukast), a dual blocker of leukotriene and inflammation pathways, is in early trials. Early results show a 60% drop in leukotriene E4 after 12 weeks-with no major side effects.

Dupilumab combined with aspirin is also showing synergy. In a 2023 trial, 78% of patients on both treatments hit a meaningful improvement in symptoms, compared to 52% on aspirin alone.

Health economists estimate that if more patients get full AERD care-surgery, desensitization, biologics-the lifetime cost per patient drops by $87,000. That’s because you avoid repeated surgeries, ER visits, and hospital stays.

Where to Get Help

If you think you have AERD, don’t wait. Most general allergists aren’t trained in this. You need a specialist.

Look for:

• Academic medical centers with allergy-immunology departments
• Centers listed by the American Rhinologic Society
• Telemedicine consults with AERD experts (now available at 35% more centers since 2020)

Ask for the “AERD Management Toolkit” from Penn Medicine-it’s free, has patient guides in 8 languages, and includes dosing charts and emergency plans.

Join the AERD Warriors community (2,500+ members) or r/SamtersTriad on Reddit. Real people share tips: using tea tree oil in saline rinses to fight fungal growth, timing aspirin with meals to avoid stomach pain, or how to talk to your pharmacist about hidden NSAIDs.

Final Thoughts

AERD isn’t rare. It’s underdiagnosed. If you’ve had asthma and nasal polyps for years, and NSAIDs make you sick, you’re not just unlucky-you might have AERD.

There’s no cure. But there’s a path to control. Steroid rinses, biologics, surgery, and aspirin desensitization can turn a life of constant congestion and surgery into one where you breathe, smell, and sleep normally again.

It takes work. It takes time. But for thousands of people, it works.