Aspirin-Exacerbated Respiratory Disease: How NSAIDs Trigger Asthma and Nasal Polyps

Most people think of aspirin as a simple pain reliever. But for about 1 in 10 adults with asthma, taking even a single tablet can trigger a dangerous reaction-wheezing, nasal congestion, and sometimes a full-blown asthma attack. This isn’t an allergy. It’s Aspirin-Exacerbated Respiratory Disease, or AERD. And it’s far more common than most doctors realize.

What Exactly Is AERD?

AERD isn’t one symptom. It’s a trio: asthma, chronic nasal polyps, and reactions to aspirin or other NSAIDs like ibuprofen and naproxen. First described in the 1960s by Dr. Max Samter, it’s also called Samter’s Triad. Unlike typical allergies, AERD doesn’t show up on skin tests or blood tests for IgE. Instead, it’s rooted in how your body handles inflammation at a chemical level.

When you take aspirin or an NSAID, it blocks an enzyme called COX-1. In most people, that’s fine. But in AERD, this blockage throws the body’s inflammatory system out of balance. Leukotrienes-powerful inflammatory chemicals-spike, while protective prostaglandins drop. The result? Your airways swell, your sinuses flood with mucus, and your nasal polyps grow faster.

This isn’t rare. About 9% of all adults with asthma have AERD. And if you have asthma and nasal polyps? The odds jump to 30%. Most people develop it between ages 20 and 50, with no family history. It doesn’t run in families. It just shows up-often suddenly.

What Happens When You Take NSAIDs?

It doesn’t take much. One Advil. One Aleve. Even a small dose of aspirin can trigger symptoms within 30 to 120 minutes. The reaction is predictable: severe nasal congestion (95% of cases), sinus pressure or headache (88%), watery or red eyes (76%), and worsening asthma-wheezing, chest tightness, coughing (92%).

But here’s what most people don’t know: alcohol can trigger the same reaction in 75% of AERD patients. Not because of the alcohol itself, but because it boosts the same inflammatory pathway. One glass of wine, one beer-sometimes even less-and you might feel your nose plug up or your breathing tighten. No one warns you about this. Many patients spend years thinking they’re just sensitive to alcohol, not realizing it’s part of a bigger condition.

Some also get nausea, stomach pain, flushing, or a rash. These aren’t side effects-they’re symptoms of AERD. And they’re not mild. One patient on Reddit wrote: “I took ibuprofen for a headache. Two hours later, I was in the ER with oxygen on my face.” That’s not an exaggeration. It happens.

Why Nasal Polyps Keep Coming Back

If you’ve had nasal polyps removed more than once, you might have AERD. In non-AERD patients, polyps come back in about 30-40% of cases after surgery. In AERD patients? It’s 70-100%. Polyps grow faster, bigger, and more aggressively. They’re not just annoying-they block your sinuses, kill your sense of smell, and make breathing harder.

Standard steroid sprays help a little, but they rarely stop the regrowth. That’s why AERD patients are 50% more likely to need repeat sinus surgeries than others with polyps. And even after surgery, symptoms return faster. The problem isn’t the surgery-it’s the disease underneath.

Why Standard Asthma Treatments Often Fail

If you’re on an inhaler and still struggling to breathe, it might not be your inhaler’s fault. AERD patients respond poorly to typical asthma meds. Only 35% get good control with standard inhaled corticosteroids and bronchodilators alone. That’s because AERD isn’t just asthma-it’s a different kind of inflammation. The cytokines IL-4, IL-5, and IL-13 are running wild, pulling in eosinophils that flood your airways and sinuses.

That’s why many AERD patients end up in the ER more often. They have 2.3 times more emergency visits and 1.8 times more hospital stays than asthma patients without AERD. Their asthma is harder to control, harder to predict, and harder to treat with common tools.

The Hidden Diagnosis: Why It Takes Years to Get Right

Most patients wait 7 to 10 years before getting diagnosed. Why? Because doctors don’t connect the dots. A patient sees their primary care doctor for asthma. Then an ENT for polyps. Then an allergist for “food sensitivity.” No one asks about aspirin or alcohol. No one says, “Have you ever had a reaction to ibuprofen?”

One patient, “PolypWarrior87,” posted on Reddit: “It took me 11 years and four ENTs before someone finally linked my asthma attacks after Advil to my polyps.” That’s not unusual. Even some allergists miss it. And when they do, patients get unnecessary surgeries, misdiagnosed allergies, and years of uncontrolled symptoms.

The key is recognizing the triad: adult-onset asthma + nasal polyps + NSAID/alcohol reactions. If you have two of these, you should be tested. If you have all three? It’s almost certainly AERD.

The Only Treatment That Actually Works Long-Term

Avoiding aspirin and NSAIDs helps you avoid reactions-but it doesn’t stop the disease. Your polyps will still grow. Your asthma will still worsen. The real game-changer is aspirin desensitization.

This isn’t a cure. But it’s the closest thing we have. Under medical supervision, you’re given tiny, increasing doses of aspirin over 2-3 days until your body adjusts. Then you take a daily maintenance dose-usually 650 mg twice a day-for life.

Studies show 85% of patients who complete desensitization see better asthma control. Sinus surgery needs drop by 60%. Polyp regrowth slows from every 6 months to every 3 years. One patient said: “After desensitization, I haven’t needed surgery in five years.”

But here’s the catch: only 12% of allergy practices in the U.S. offer it. It requires an inpatient stay. You need a specialist who knows how to do it safely. And it’s not for everyone. About 42% have bad reactions during the process. But for those who stick with it? Quality of life improves by 68%.

What About New Drugs Like Dupixent?

Biologics like dupilumab (Dupixent) are changing the game. Approved for nasal polyps in 2019, it reduces polyp size by 50-60% in AERD patients. It’s given as an injection every two weeks. But it costs $38,500 a year-and only 38% of patients have insurance that covers it.

Still, usage is rising. In 2018, only 15% of AERD specialists used biologics. Now, it’s 65%. For patients who can’t do aspirin desensitization-or who still have symptoms after it-dupilumab is a lifeline. But it doesn’t fix the root cause. It just suppresses the inflammation.

There’s also new hope on the horizon. A drug called MN-001 (lodadustat), a new leukotriene blocker, showed a 70% drop in polyp recurrence in early trials. It’s not approved yet, but if it works in larger studies, it could be a cheaper, easier alternative to daily aspirin.

Who Gets Left Behind?

Despite all the science, AERD is still a disease of inequality. Black and Hispanic patients wait 3.2 years longer for diagnosis than White patients. Rural patients can’t access the 35 specialized centers in the U.S. that treat AERD. Most care happens in academic hospitals-only 22% of patients are managed in community clinics.

And the cost? AERD generates $1.8 billion in annual U.S. healthcare spending-mostly from repeat surgeries and ER visits. That’s not just money. It’s lost workdays, missed school, sleepless nights, and constant fear of the next reaction.

What Should You Do If You Suspect AERD?

If you have asthma and nasal polyps, and you react to aspirin, ibuprofen, or alcohol-don’t wait. Talk to an allergist who specializes in AERD. Ask about:

• Aspirin desensitization
• Biologic therapy options
• Testing for leukotriene levels
• Keeping a symptom diary tied to NSAID and alcohol use

Don’t assume your reactions are “just allergies” or “bad luck.” You’re not alone. Over 1.2 million Americans have AERD. And there’s a path forward-even if it’s not easy.

Start with the Samter’s Society website. They have free patient guides, videos, and a directory of specialists. Print out their symptom checklist. Bring it to your next appointment. Be the one who asks the right questions.

Because if you’ve spent years trying to manage asthma with inhalers while your polyps keep coming back-you’re not failing. The system is.