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Aspirin Exacerbated Respiratory Disease (AERD)

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KEY POINTS

  • Asthma is a chronic lung disease that can cause shortness of breath, coughing, wheezing, and sometimes chest tightness. AERD can trigger asthma by taking aspirin, ibuprofen, naproxen, or other NSAIDs.
  • Treatment may include asthma medicines that your child inhales or takes by mouth. Some children may be treated with a kind of therapy called aspirin desensitization. This process must be supervised by an experienced healthcare provider.
  • To help prevent AERD, help your child avoid products that contain aspirin. Be sure to read labels. Several medicines contain aspirin or other NSAIDs.

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What causes aspirin exacerbated respiratory disease (AERD)?

Asthma is a long-lasting (chronic) lung disease. It can cause shortness of breath, coughing, wheezing, and sometimes chest tightness.

Aspirin exacerbated respiratory disease (AERD) can trigger asthma in some people after they take aspirin or other NSAIDs. Aspirin, ibuprofen, and naproxen are NSAIDs. People with asthma should use NSAIDs with caution.

This kind of asthma is not common in children.

What are the symptoms?

The first symptoms of AERD may include sneezing, a runny or stuffy nose, and redness and warmth of the face. Symptoms start 1 to 3 hours after taking aspirin or NSAIDs. AERD triggered by aspirin and NSAIDs can be life threatening. In many cases, people with AERD also have nasal polyps (growths in the lining of the nose or sinuses), long-term sinus disease, and loss of the sense of smell.

Children with asthma may not be sensitive to aspirin at first. They may have taken aspirin or NSAIDs in the past without any side effects. Symptoms may not start until adolescence or adulthood.

How is it diagnosed?

There are no blood tests or skin tests that will diagnose allergy to aspirin or NSAIDs. Your child's healthcare provider will ask:

  • Your child’s use of aspirin
  • How often your child is having symptoms
  • Any other allergies or triggers

The provider may refer your child to an allergy specialist to see if your child has other allergies.

How is it treated?

If your older child has been diagnosed with AERD, do not give your child products that contain aspirin.

In general, AERD is managed in the same way as other types of asthma. Your child may need one or more of these medicines to control asthma:

  • Controller medicines help prevent asthma attacks and control your child’s symptoms. When a steroid inhaler is used with certain medicines such as formoterol, your child gets both rapid relief and control. There are several kinds of controller medicines for asthma.
  • Rescue inhalers, also called reliever or quick relief medicines, act quickly to reduce symptoms. These medicines are used as needed to treat asthma attacks. Rescue inhalers work fast to relax the muscles of your child’s airways and keep the muscles from getting too tight. Your child should learn to recognize the symptoms of an asthma attack and take these medicines as soon as symptoms start. To prevent asthma attacks, your child may need a different type of medicine called a controller.

Some children may be treated with a kind of therapy called aspirin desensitization. Your child starts by taking a very small dose of aspirin in a medical setting where there is emergency support. This process must be supervised by an experienced healthcare provider. Do not let your child try this alone. The dose is carefully and gradually increased until a normal dose of aspirin can be taken without causing symptoms. As the dose is increased, there is a chance of a sudden asthma attack. Once your child can take a normal dose of aspirin without having symptoms, your child will keep taking that dose every day. As this happens, your child’s symptoms will decrease. This can reduce the need for asthma medicines and improve asthma symptoms.

Your child should carry an ID card or wear a medical ID bracelet or necklace that says he or she cannot take aspirin, ibuprofen, naproxen, or other NSAIDs. If your child needs emergency care, surgery, or lab tests, this helps the healthcare provider know how to treat your child.

Can it be prevented?

AERD can be prevented. Avoid products that contain aspirin. Be sure to read labels. Several medicines contain aspirin or other NSAIDs.

Do not give aspirin to children 18 years or younger unless told to do so by your healthcare provider. This is due to the risk of Reye syndrome, an illness that causes inflammation of the brain and liver.

If your child has asthma, use NSAIDs such as ibuprofen with caution. If your child has asthma and nasal polyps, do not use NSAIDs without the approval of your child’s healthcare provider.

In rare cases, acetaminophen may also trigger an asthma attack. Reactions are usually less intense than reactions to aspirin or other NSAIDs. Acetaminophen is the medicine most often used for fever and pain relief for people who cannot take aspirin and NSAIDs.

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2021-12-07
Last reviewed: 2021-06-15
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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