Aspirin-Exacerbated Respiratory Disease: More Common Than You Think

the MPR take:

Although previous numbers for aspirin-exacerbated respiratory disease (AERD) have varied widely, new findings suggest that it is present in approximately 7% of the adult asthmatic patient population, with that number doubled in patients with severe asthma. Published in the Journal of Allergy and Clinical Immunology, a meta-analysis sought to determine the prevalence of AERD in asthmatic adults, as well as among those with nasal polyposis and chronic rhinosinusitis. 159 articles published from 1968–2012 were identified and researchers calculated that the prevalence rate for adult asthmatic patients was 7.2% and 14.89% for those with severe asthma. Among patients with nasal polyps and chronic rhinosinusitis, the rates were 9.7% (95% CI, 2.16–17.22%) and 8.7% (95% CI, 21.02–18.34%), respectively. In reviewing AERD rates based on method of diagnosis, questionnaires were found to be the least reliable due to issues with patient recall; oral aspirin challenge is the current diagnostic standard but premedications like leukotriene receptor antagonists, 5-lipoxygenase inhibitors, and antihistamines may mask what would otherwise have been a positive test result. Previous studies have indicated that as many as 20% of adult asthmatic patients have AERD, but these results suggest a much lower prevalence yet it is still more common than many physicians would suspect, added the study authors.

Aspirin-exacerbated respiratory disease (AERD) is manifested by adult-onset asthma, nasal polyposis, chronic rhinosinusitis, and aspirin sensitivity. Previously reported prevalence rates have been widely variable based on the population studied, method of diagnosis, and definition of aspirin sensitivity.