Penn's Coordinated Approach to AERD Care
The
Penn AERD Center was designed to provide seamless, coordinated care to patients with
AERD.
Because AERD treatment requires complex, individualized care for optimal results, Medical Director John V. Bosso, MD, and Surgical Director Nithin D. Adappa, MD, work closely together — discussing each patient throughout care and at the The Penn AERD Center's regular multidisciplinary conference. It is with this coordination of medical and surgical treatment options — often during the same appointment — that Penn is able to deliver exceptional care for those with AERD.
AERD Treatment
How to Prepare for AERD Treatment
Patients must have their asthma well controlled before AERD treatment can begin.
What to Expect
Optimal treatment for patients with AERD includes sinus surgery to remove nasal polyps, followed by aspirin desensitization.
Aspirin desensitization is an effective therapy that treats the underlying cause of AERD, making it much more effective than treatment options that solely include repeated surgical sinus procedures, medications, and inhalers, which only suppress symptoms.
Sinus Surgery
The first step in AERD treatment is to ensure the sinuses are completely clear. This involves what’s known as a complete endoscopic sinus surgery, where all eight sinuses are cleared of any polyps.
It is important to have your surgery performed by a physician with extensive AERD experience, as it is one of the most severe forms of nasal polyposis. A thorough cleanout including removal of all polyps along the skull base and frontal sinus is needed in order to give the best results with aspirin desensitization.
After surgery, low dose prednisone and debridement, a procedure to clean your nose and sinuses, is often needed to render the sinus cavities clean. The patient is typically ready to undergo aspirin desensitization six to eight weeks after sinus surgery.
Aspirin Desensitization
After the sinuses have been cleared, aspirin desensitization can begin. The procedure consists of introducing gradually increased doses of aspirin in a controlled medical environment, beginning first with a nasal spray formulation of an NSAID and then progressing to oral aspirin. The doses are then slowly increased over two consecutive outpatient days until the full dose is reached. At that point, you are considered desensitized.
Desensitization to aspirin is usually accomplished in a two-day period. Infrequently, a third day is necessary. After each session, patients are allowed to go home for the day. They must return the next morning until the procedure is completed.
After desensitization, you will take a full adult dose of aspirin daily to remain desensitized. This helps reduce the risk of new nasal polyps forming or worsening asthma. If you go more than 48 to 72 hours without taking aspirin, the desensitization procedure loses its effect and you would need to repeat it to get the protective effects of the aspirin.
Safety & Risks
Even if you previously had severe reactions to NSAIDs, aspirin desensitization can be performed safely. It is performed in a controlled medical environment to be able to treat any symptoms experienced during desensitization.
Throughout the procedure, your doctor will be continuously monitoring your condition and a nurse will be with you the entire time.
Breathing tests, vital sign checks, and pulse oximetry which measures oxygen levels by placing a device on your finger, are frequently performed, and an intravenous line (IV) will be placed into your arm so that medications can be given if needed. As soon as you begin to have symptoms, you will be given treatment to quickly and effectively reverse the reaction. Many patients do not experience anything more than minor symptoms.
Benefits of Coordinated Sinus Surgery & Aspirin Desensitization for AERD
Patients who have AERD often find relief from sinus surgery followed by an aspirin desensitization protocol, frequently resulting in a dramatic reduction of symptoms and improved quality of life in the vast majority of patients.
Benefits usually include:
- Decreased nasal congestion
- No regrowth of nasal polyps
- Less medication (especially oral corticosteroids like prednisone) to control polyps and asthma
- No further sinus surgeries
- Reduced asthma attacks
- Less sinus infections, and therefore less antibiotic usage
- Improved sense of smell
- Improved tolerance to alcohol
- Overall improved quality of life