What Is Aspirin-Exacerbated Respiratory Disease?

Medically Reviewed by Carol DerSarkissian, MD on August 03, 2022
4 min read

You might reach for aspirin, ibuprofen, or naproxen to relieve a headache, lower a fever, or ease joint pain from arthritis or another condition. But if you have a disorder known as aspirin-exacerbated respiratory disease (AERD), you may feel worse after you take them. Fortunately, AERD is often a treatable condition.

AERD is an extreme sensitivity to a type of medicine doctors call NSAIDs. That’s short for non-steroidal anti-inflammatory drugs. AERD causes breathing problems such as asthma. It can also mean you often get sinus problems with nasal polyps.

Among people with asthma, it’s not uncommon. About 9% of all adults with asthma and about 30% of adults with both asthma and nasal polyps have AERD, also known as Samter’s triad.

AERD usually comes on suddenly. It usually first affects people between the ages of 20 and 50. Doctors don’t always know what triggers AERD or why some people get this condition.

NSAIDs and aspirin block an enzyme called COX1, which promotes pain and inflammation. If you have AERD, that blocking action could backfire. Your body might make too much of things called leukotrienes. And that, in turn, can bring on breathing problems similar to allergic reactions.

Researchers don’t know why aspirin leads to high levels of leukotrienes in some people. But if you’ve ever been a smoker, that may mean you’re at risk for AERD. The same is true if you were exposed to secondhand smoke when you were a child.

Taking aspirin or an NSAID in any form can quickly launch symptoms, including an asthma attack. Even if you avoid these medications after you’ve discovered that you’re aspirin-sensitive, you may still have a range of breathing and nasal problems for the rest of your life.

AERD can cause symptoms of upper respiratory problems, such as:

  • Nasal congestion and a stuffy nose
  • Recurring nasal polyps
  • Red and watery eyes
  • Headache
  • Sinus pain
  • Sneezing

Symptoms of lower respiratory distress and asthma also develop with AERD. These include:

You may also feel unusual fatigue and dizziness with AERD. Sometimes, you might also have abdominal cramps and nausea.

In serious cases, you might have a lot of sinus infections and even lose your sense of smell eventually. There can be more complications if you have AERD and drink alcohol. About 75% of people with AERD develop mild-to-moderate respiratory problems after drinking alcohol. Even drinking less than one serving of alcohol can cause a reaction.

You can’t take a blood test to see if you have AERD. Instead, your doctor can check for Samter’s triad, which includes asthma, nasal polyps, and a respiratory reaction when you take NSAIDs. If you have those three things, then your doctor may diagnose it as AERD.

If your doctor wants to confirm that your reaction is due to aspirin or NSADs, you may take an “aspirin challenge.” While your doctor is watching (in case you have an extreme reaction), you’ll swallow an aspirin or NSAID, or inhale a nasal spray containing an NSAID, in gradually stronger doses.

If you have asthma that isn’t under control or you’ve had a recent respiratory infection (like a cold or the flu), you shouldn’t take the aspirin challenge. Pregnant women and anyone with heart, liver, or kidney disease should also avoid this test.

Although there’s no cure for AERD, there are ways to manage it.

Your doctor may prescribe inhaled steroids that you take daily to treat asthma. Intranasal steroid sprays or steroid sinus rinses can help nasal symptoms. Your doctor can inject steroids into the polyps to help shrink them or remove them.

Some people with AERD may eventually be able to safely take NSAIDs through a process called aspirin desensitization. While your doctor watches, you start by taking a small dose of aspirin. Each day your doctor will give you a slightly larger dose until you have symptoms. You will then get that dose daily until you have no reaction. Then your doctor will increase the dose again. When you have a reaction, you’ll stay on that dose until you can handle it easily. Then the process starts again.

Aspirin desensitization works in nearly 9 out of 10 people. They can then take NSAIDs without triggering AERD symptoms.

Nasal polyps can affect your senses of smell and taste. This is one of the biggest complaints among people with AERD. Sometimes removing polyps and keeping your nasal passages clear can help restore your sense of smell. You can also try spicing up your food to make it more flavorful.

If you have not gone through aspirin desensitization, you should avoid all types of NSAIDs, including low-dose (“baby”) aspirin. If your doctor recommends a daily low-dose aspirin to help prevent a heart attack, talk about whether you can try aspirin desensitization.

Acetaminophen isn’t an NSAID, so if you take it for fevers and pain, it won’t trigger AERD. Remember to tell your doctors about your AERD, especially if you have to have a procedure, so that you don’t get NSAIDs for pain.

You may still have some AERD-like symptoms even after you stop taking aspirin or NSAIDs. That’s because you may be prone to allergies or other respiratory problems that would have developed even if you had never swallowed an aspirin. Even so, it’s important that you don’t take NSAIDs or it could make the underlying problem, such as asthma or sinus infections, much worse.