Management of nasal polyps in 'aspirin sensitive asthma' triad

Aspirin-sensitive asthma (ASA) triad is a challenging picture presenting to both the otolaryngologist and the respiratory physicians. Patients present with severe nasal polyposis with a high propensity to recur despite the modality of treatment - medical or surgical. They also often have poorly controlled severe adult onset asthma. We reviewed the scientific literature, focusing on the outcomes of these treatment modalities in the management of nasal polyposis in ASA triad.

Although initial work described by Widal on the subject continues, in the last decade a number of prospective and retrospective studies on outcomes after aspirin desensitization as well as surgery have been reported. The extent of surgery has also been addressed in some of these studies. Medical as well as surgical treatments have a role but there has been increasing evidence to support the role of aspirin desensitization in achieving long-term control of this condition.

Overall, with the limitation of data, it appears more is better in patients with ASA and nasal polyposis. There is a lack of level 1 evidence in the proposed treatment modalities. Questions on extent of surgery and dosage as well as length of aspirin desensitization require further research with minimally biased controlled studies.