Brigham and Women’s Hospital (BWH) offers a special program to meet the needs of patients with aspirin exacerbated respiratory disease (AERD). This acquired condition is common in patients with asthma, and is not well understood. BWH offers a specialized program for treating AERD patients and conducting research to learn more about the disease.
AERD, also known as Samter’s Triad or aspirin-sensitive asthma, is a chronic medical condition that affects patients with asthma. Along with the common symptoms of asthma, patients with AERD also experience recurrent sinus disease with nasal polyps and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10 percent of all adults with asthma and 40 percent of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
AERD affects about one million people or seven percent of all adults with asthma. Symptoms include asthma, nasal polyps and respiratory reactions to asthma. Watch this video of Dr. Tanya Laidlaw as she describes how AERD is diagnosed and treated. Or, read the Aspirin Exacerbated Respiratory Disease: Recognition and Treatment video transcript.
Allergy and immunology specialists at BWH have established a safe and effective aspirin desensitization program for patients with AERD. This one-day desensitization protocol enables patients to safely tolerate aspirin, as long as the aspirin is taken daily. About 70 percent of AERD patients who have undergone the one-day treatment regimen report reductions in nasal polyp growth, a decrease in the frequency of sinus infections, and improvements in their asthma symptoms.
The desensitization process at BWH is generally performed in an outpatient clinic setting over the course of one day, but admission to our hospital may be preferred for some patients with severe asthma or a history of very severe reactions to aspirin. Initially, the patient will be given a very low dose (20-40 mg) of aspirin, and then gradually higher doses of aspirin are given every one-and-half to three hours while the patient is closely monitored. The symptoms and severity of reactions vary from person to person, and, therefore, the exact protocol for each desensitization procedure is individualized for each patient.
During the reaction, your symptoms are likely to include one or more of the following:
During a successful desensitization procedure, these symptoms will continue to lessen in severity until the patient experiences no reaction at all to a standard dose of aspirin.
Patients with AERD who have not been desensitized to aspirin should avoid using aspirin or other NSAIDs. Acetaminophen (Tylenol) is usually well-tolerated at low doses (below 1000 mg) and may be used as an alternative pain-killer, but some patients experience mild reactions if they take acetaminophen at higher doses.
Although complete avoidance of aspirin and NSAIDs is important, AERD patients who haven’t been desensitized will continue to develop nasal polyps, nasal congestion, sinusitis, and other symptoms of asthma.
Many AERD patients require medications to control their asthma symptoms and often need to use daily inhaled corticosteroids. Intranasal steroid sprays or nasal/sinus steroid irrigation can be helpful to control symptoms of chronic rhinosinusitis and nasal polyps. Nasal polyps also can be treated with intra-polyp steroid injections.
Medications that block the production or actions of leukotrienes (substances that cause inflammation) have been found to provide some benefit in treating the symptoms of AERD and reducing the severity of reactions to aspirin and NSAIDs.
Sometimes, it is necessary to surgically remove nasal polyps. However, the rate of recurrence of nasal polyps after surgery is quite high.
The Brigham and Women’s Hospital (BWH) Division of Rheumatology, Immunology and Allergy, consistently ranked as one of the top five rheumatology programs in the country by U.S. News and World Report®, is internationally renowned for excellence in clinical care, clinical investigation, and basic research. Inflammatory and immune disorders can affect many systems in the body, so our clinicians collaborate closely with specialists throughout Brigham and Women’s Hospital to provide each patient with comprehensive, multidisciplinary care. This care also is extended to the family and loved ones of our patients; this step is instrumental to our goal of doing everything possible to improve our patients’ health.
BWH has long been committed to not only the care of our patients but also the many other needs that they and their families have. This philosophy of patient- and family-focused care – involving systems and services that emphasize healing in a comfortable, relaxed environment – is a guiding force behind the care we provide.
BWH is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and follows established protocols that have been shown to improve patient outcomes. Our Inpatient Satisfaction Survey, sent to patients’ to assess their total care experience, helps us to monitor what we are doing well and where we could improve. We pride ourselves in the Quality of Patient Care we provide and how we compare with other hospitals.
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