Clinical and mechanistic advancements in aspirin exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is characterized by the clinical triad of chronic rhinosinusitis with nasal polyps, asthma, and a hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). AERD is estimated to occur in as many as 15% of patients with chronic rhinosinusitis with nasal polyps and/or asthma. Uniquely, patients with AERD develop respiratory symptoms within 30 to 180 minutes after ingesting NSAIDs such as aspirin or ibuprofen. However, even in the absence of NSAIDs, patients tend to have more severe upper and lower respiratory disease. The underlying pathogenic mechanisms contributing to AERD are complex and intertwined; they include a systemic dysregulation in arachidonic acid metabolism, an aberrant inflammatory response, a disruption in the respiratory epithelial barrier, and an imbalance between the formation and degradation of fibrin locally in nasal polyps. This review will highlight novel mechanistic findings contributing to the pathogenesis of AERD. In addition, recent advancements in the clinical understanding and management of patients with AERD will be discussed.