Aspirin-Exacerbated Respiratory Disease: State-of-the-Art Multidisciplinary Management in 2023

PROGRAM DESCRIPTION: Aspirin-exacerbated respiratory disease (AERD) is a syndrome consisting of chronic rhinosinusitis with nasal polyposis, respiratory reactions to nonsteroidal anti-inflammatory drugs and eosinophilic asthma. AERD affects approximately 0.9% of the general population in the United States. The prevalence of AERD is much higher among certain groups including asthmatics (10-20%), patients with nasal polyposis (10%) and in asthmatics with polyposis (40%).

Despite an increased recognition of this disease entity, there continues to be an average delay of 10 years between onset of symptoms and the formal diagnosis of AERD. Once diagnosed, the adequate management of symptoms in AERD patients continues to be a challenge. Despite the introduction of several new medical treatment options, such as immunomodulating biologics, and surgical options including extended endoscopic sinus surgery, the respective roles of medical and surgical treatment options in the management of AERD has yet to be fully established.

This mini-seminar will engage attendees in an evidence-based discussion incorporating real cases. Attendees will learn about the efficient diagnosis of AERD including the importance of timing of the diagnostic aspirin challenge and the need for coordination of the management plan with allergy providers. Attendees will achieve insight into the role of endoscopic sinus surgery, including extended sinusotomies, nasalization, and resection of involved structures, all of which will be debated. The role of aspirin therapy in the era of biologics and the nuances of these treatment approaches will be discussed. Evidence related to the use of biologics will be critically appraised. Attendees will gain an understanding of the optimal timing of medical and surgical interventions.

The multidisciplinary panel consists of academic specialists in allergy/immunology and rhinology with considerable expertise in AERD.

OUTCOME OBJECTIVE 1: Understand how to efficiently identify potential cases of AERD and confirm the diagnosis through history, physical examination and objective testing.

OUTCOME OBJECTIVE 2: Review the evidence underlying the role of aspirin therapy, immunomodulating biologics and adjunctive treatments in the management of AERD.

OUTCOME OBJECTIVE 3: Discuss the role of primary and revision endoscopic sinus surgery in controlling AERD, and appreciate where surgery fits in the context of advanced medical therapies.

BACKGROUND STATEMENT: The treatment of AERD is increasingly complex, encompassing classic aspirin therapy, immunomodulating biologics and endoscopic sinus surgery, including extended approaches. This panel will help members navigate this intricate management puzzle.