What Is Aspirin-Exacerbated Respiratory Disease?
Aspirin-Exacerbated Respiratory Disease, or AERD, is not just a bad reaction to painkillers. It’s a chronic condition that hits adults between 20 and 50, mostly women, and it changes how your airways work. People with AERD have three things in common: asthma, nasal polyps, and severe breathing reactions when they take aspirin or common NSAIDs like ibuprofen or naproxen. These reactions aren’t allergies in the classic sense-they’re triggered by how the body handles inflammation chemicals, not by antibodies. When COX-1 enzymes are blocked by these drugs, the body overproduces leukotrienes, which cause swelling, mucus, and bronchospasm. Think of it like your airways going into overdrive when you take a regular pain reliever.
Up to 7% of all adults with asthma have AERD, and if you have nasal polyps along with asthma, your risk jumps to 14%. Most people don’t realize they have it until they take aspirin for a headache and suddenly can’t breathe. Symptoms can hit within 30 to 120 minutes: wheezing, nasal congestion, coughing, even facial flushing or stomach cramps. For many, it’s not the first time they’ve had trouble breathing-they’ve had chronic sinus infections, loss of smell, or frequent sinus surgeries for years without knowing why.
How Is AERD Diagnosed?
There’s no blood test or scan that confirms AERD. Diagnosis relies on your story-your medical history. If you’ve had asthma since adulthood, recurring nasal polyps that come back after surgery, and breathing problems after taking aspirin or NSAIDs, doctors will suspect AERD. But sometimes the history is unclear. Maybe you’ve avoided NSAIDs for years and never got tested. Maybe you only reacted once, years ago, and didn’t think much of it.
When the history isn’t clear, the gold standard is an aspirin challenge. This isn’t something you do at home. It’s done in a hospital or specialized allergy clinic with emergency equipment on standby. You start with a tiny dose-20 to 30 milligrams of aspirin-and every 90 to 120 minutes, the dose doubles. You’re monitored closely for drops in lung function, wheezing, or nasal swelling. The test ends when you hit 325mg (a regular aspirin tablet) or if symptoms appear. About 90% of people with AERD react during this test. It’s uncomfortable, sometimes scary, but it’s the only way to be sure.
Doctors also look at supporting clues: blood tests showing high eosinophils (over 500 cells/μL), or elevated levels of leukotriene E4 in your urine. These aren’t diagnostic on their own, but they add up. If you’ve had three or more sinus surgeries, your asthma worsened after age 30, and you can’t take ibuprofen without coughing, you’re likely dealing with AERD.
Medical Management: Beyond Avoiding Aspirin
A lot of people think the solution is just to avoid aspirin and NSAIDs. But here’s the catch: avoiding these drugs doesn’t stop the disease. The inflammation keeps going. Nasal polyps keep growing. Asthma keeps flaring. You still need active treatment.
The first line of defense? Steroid sinus rinses. Using a neti pot or squeeze bottle with 50 to 100mg of budesonide twice a day reduces polyp size by 30-40% in just eight weeks. It’s not glamorous, but it works better than oral steroids for most people. Combine that with a daily nasal spray like fluticasone (two sprays per nostril, twice a day), and nasal congestion improves by 35% on standard symptom scores.
For asthma, most patients need a combination inhaler-like fluticasone/salmeterol-two puffs twice a day. This improves lung function by 15-20%. If that’s not enough, doctors add a leukotriene modifier. Zileuton blocks the production of leukotrienes and cuts urinary levels by 75% in two weeks. About 28% of patients say it’s “extremely effective.” Montelukast (Singulair) is easier to take but less powerful-only 15% report major benefit.
For the worst cases, biologics are changing lives. Dupilumab (Dupixent), injected every two weeks, shrinks nasal polyps by 55% and improves quality of life scores by 40% in 16 weeks. Mepolizumab (Nucala), given monthly, cuts eosinophil counts by 85% and reduces the need for repeat sinus surgery by over half. These aren’t cheap-each shot costs thousands-but for patients stuck in a cycle of surgeries and steroid bursts, they’re life-changing.
Aspirin Desensitization: The Game-Changer
If you’ve had multiple sinus surgeries and your polyps keep coming back, you’re a candidate for aspirin desensitization. This isn’t just taking aspirin daily. It’s a controlled process that rewires your body’s response.
The procedure is similar to the diagnostic challenge-but instead of stopping when you react, you keep going. You’re given escalating doses over two days until you reach 325mg without symptoms. Then, you start taking 650mg twice daily, every day, for the rest of your life. No skipping. No breaks.
Why go through this? Because it works. After desensitization and daily aspirin, the need for oral steroid bursts drops from 4.2 times a year to just 1.1. Polyp recurrence after sinus surgery falls from 85% to 35% over two years. Smell returns for most people-the University of Pennsylvania Smell Test shows scores jump from 12.4 to 23.7 out of 40. People report smelling coffee, rain, or their kids’ shampoo again after years of nothing.
It’s not perfect. About 22% of people get stomach ulcers or bleeding and need to lower their dose. If you miss two or three days of aspirin, your body loses tolerance. You have to go through the whole desensitization again. That’s why adherence is everything. Patients who stick with it report the best outcomes: fewer surgeries, better breathing, and a real return to normal life.
When Surgery Fits In
Functional endoscopic sinus surgery (FESS) is often part of the plan. It removes polyps and opens blocked sinuses. Alone, it gives 70-80% symptom relief-but 60-70% of people get polyps back within 18 months.
When you combine FESS with aspirin desensitization, recurrence drops to 25-30% at two years. That’s a 65% reduction in polyp regrowth compared to surgery alone. Experts now say: if you’re having sinus surgery for AERD, you should be offered desensitization before you leave the hospital. It’s not optional-it’s the standard of care.
But not everyone qualifies. If you have severe heart disease, active peptic ulcers, or can’t commit to daily aspirin, desensitization isn’t safe. About 15% of candidates are turned away for these reasons. For them, biologics become the main tool.
Real People, Real Challenges
Patients on forums like AERD Warriors and Reddit’s r/SamtersTriad talk about the emotional toll. One person wrote: “I hadn’t smelled my wife’s perfume in 12 years. After desensitization, I caught it on the breeze one morning and cried.” Another said: “I thought I’d need another surgery every year. Now it’s been four years and I’m polyp-free.”
But it’s not all success stories. The aspirin challenge is rough-32% of patients say it felt like a panic attack. Biologics are out of reach for many: 65% of patients earning under $50,000 a year say they can’t afford them. And hidden NSAIDs are everywhere. Cold meds, topical creams, even some vitamins contain ibuprofen or naproxen. Patients have to become label detectives.
Some find small wins: adding a drop of tea tree oil to saline rinses to fight fungal growth, or taking aspirin with food to avoid stomach upset. These aren’t cures, but they help manage the daily grind.
Access and the Future of AERD Care
There are only about 35 dedicated AERD centers in the U.S. Most are in big cities. If you live in rural Montana or Mississippi, getting a proper diagnosis or desensitization can mean driving 200 miles. Telemedicine has helped-35% more patients are getting specialist input since 2020-but access is still unequal.
Doctors need training too. Only 18% of U.S. allergists feel confident managing AERD. That’s why standardized protocols from places like Penn Medicine are so important. They offer downloadable checklists, patient handouts in eight languages, and EHR templates that make it easier for clinics to adopt best practices.
On the horizon: new drugs like MN-001 (tipelukast), which blocks two inflammatory pathways at once. Early results show a 60% drop in leukotriene levels with no major side effects. And studies now show that combining dupilumab with aspirin gives even better results than either alone.
The long-term math is clear: integrated AERD care-surgery, desensitization, biologics, and consistent meds-can save $87,000 per patient over their lifetime by cutting hospital visits and repeat surgeries. But only if they can get to the right care.
What You Should Do Next
If you have asthma and nasal polyps, and you’ve ever had trouble breathing after taking aspirin or ibuprofen, talk to an allergist or ENT who specializes in AERD. Don’t wait until you’ve had your third surgery. Ask about:
- Getting an aspirin challenge to confirm diagnosis
- Starting daily steroid sinus rinses
- Whether you’re a candidate for aspirin desensitization after surgery
- Biologic options if your symptoms aren’t controlled
This isn’t a condition you manage alone. It takes a team: an allergist, an ENT surgeon, and a patient who’s willing to stick with the plan. But for those who do, the difference isn’t subtle-it’s life-changing.
Cassie Widders
January 11, 2026 AT 15:00