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The Little-Known Side Effect of Aspirin Asthma Sufferers Need to Know About

If you have asthma, you’ll want to be on the lookout for a reaction that can happen after taking common pain relievers

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Photo Collage: AARP; (Source: Getty Images)

Plenty of people pop an aspirin here or there to ease aches and pains, and, in certain instances, to help prevent a heart attack or stroke. Aspirin is so ubiquitous in our medicine cabinets that 1 in 4 adults ages 50 to 80 say they take the over-the-counter med at least three days per week, according to a March report from the University of Michigan's National Poll on Healthy Aging, supported by AARP and Michigan Medicine.

But for a select group of adults, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) — like ibuprofen and naproxen — can worsen their breathing problems, even sending some to the ER.

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What is AERD?

We’re talking about aspirin-exacerbated respiratory disease, or AERD, which affects about 9 percent of adults with asthma, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). “AERD is a chronic inflammatory disease of the respiratory tract primarily involving the sinuses and the airways in the lungs,” says John Bosso, M.D., the medical director of the Penn AERD Center and professor of Clinical Otorhinolaryngology: Head and Neck Surgery at Penn Medicine.

AERD has three main features, says Kirk Waibel, M.D., who is board certified in allergy and immunology at Aspire Allergy & Sinus in San Antonio, Texas:

  • Asthma, which may be difficult to control
  • Underlying sinus disease with nasal polyps (benign growths in the nasal cavity)
  • Reaction to aspirin or other NSAID medications

All of these things don’t happen all at once. People with AERD tend to develop the reaction to an NSAID about nine months after being diagnosed with asthma, though it can take years, according to one study published in 2019 in the journal International Forum of Allergy & Rhinology. And although the average age of diagnosis is in one’s 30s, Bosso says their center has seen new diagnoses as late as the early 60s. “Just because you’ve made it past a certain age doesn’t mean you can’t have this condition,” he says.

The fortunate news is that AERD becomes less aggressive after menopause and as you get into your 70s – and beyond, and it can be easier to manage, Bosso says.  

Symptoms of AERD can include:

  • Sneezing
  • Profuse runny nose
  • Nasal congestion
  • Coughing
  • Wheezing
  • Shortness of breath
  • Throat tightness
  • Chest tightness

What happens in AERD is that there is a dysregulation in inflammatory pathways, so that when you take aspirin or another NSAID, your body releases certain chemicals that create a reaction within three hours of taking it, Bosso says. “We don’t understand what starts the disease, but perhaps there’s a breakdown of the lining of the sinuses or respiratory tract, resulting in an ongoing inflammatory process,” he explains.

Although aspirin is in the name, it’s not exactly the main problem. “Aspirin is not the cause of the condition. Aspirin and NSAIDs exacerbate the underlying inflammation, but you still have this inflammation even when you don’t take the medication,” Bosso says.


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Diagnosing AERD

A delay in diagnosis for AERD is common. “Often people don’t put the pieces together because patients are seeing one doctor for their polyps, another for asthma, and then going to the ER for the reaction, and they may not realize there’s a relationship between those three,” Bosso says.

However, there is a growing awareness of AERD among medical professionals, he says, as it’s being taught more often in medical schools. For the right diagnosis, “it really takes someone listening and trying to think outside the box — not just staying problem-focused but thinking about what else is going on and how do these pieces fit together?” he adds. 

Listening to your symptoms and health history is one of the main ways doctors diagnose AERD, but they may also call for an aspirin challenge, Bosso says. This means going into a health care setting and purposefully taking aspirin to see if the drug causes an irritation or provokes an asthma flare-up. Don’t try this on your own — you’ll want to do it only under doctor supervision.

“One of the main messages is if you have adult asthma, think about what triggers a flare-up of your disease. For 10 percent, aspirin will certainly be one of those,” Waibel says.

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Treatment for AERD

Having this condition is known to severely affect your quality of life, according to Waibel. “You’re always stopped up in the nose and have to breathe through your mouth, you can’t smell, and you experience constant pain and pressure. No one wants to walk around blowing yellow-green snot all the time,” he says.  

In short, it’s important to properly identify AERD and get treated for it. But treatment isn’t just about avoiding aspirin or NSAIDs, as a number of older adults need to take these drugs for a variety of reasons.

“Avoiding the medications will prevent the reactions, but not prevent the disease from progressing. The inflammation continues — it doesn’t go on holiday,” Bosso says.

Although there is no cure for AERD, treatment may involve a combination of the following:

  • Surgery: With your nasal passages constantly filled with polyps, medication can’t do its job. Often the first step, sinus surgery is usually needed to remove nasal polyps. “Surgery is a reset that gets your disease back to a more manageable level,” Bosso says.
  • Topical steroids: With nasal passages cleared out, topical steroids can then reach the sinuses and get into the lining where they can effectively reduce inflammation, Bosso says.
  • Aspirin desensitization: A month or two following surgery, aspirin desensitization helps prevent the regrowth of new disease, Bosso explains. This is a process of giving you a small amount of aspirin and gradually increasing dosage, which allows your body time to accept the aspirin and stop the reaction. “When desensitized, the inflammatory cells shut down,” he says, adding that 85 to 90 percent of patients at the Penn Medicine AERD Center respond to this therapy. The catch is that you have to take aspirin daily long-term, which is not recommended for everyone. But this also allows you to take NSAIDs as needed.
  • Other treatment options: If you have GI issues, such as stomach irritation while taking aspirin, the desensitization treatment isn’t for you. In that case, biologic medications, such as dupilumab (Dupixent), omalizumab (Xolair) or mepolizumab (Nucala), which are federally approved to treat asthma and nasal polyps, may be helpful, especially if your disease is resistant to the other treatments.

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