Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease: diagnosis and current management

Nonsteroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD) is a unique and often clinically severe disease affecting a subgroup of adults with asthma, chronic rhinosinusitis with nasal polyposis, and respiratory reactions with exposure to all cyclooxygenase (COX-1) inhibiting nonsteroidal anti-inflammatory drugs (NSAIDS). N-ERD has a high disease burden and is estimated to affect 7% of adult asthmatics and 30% of patients who have both asthma and nasal polyps. The disease is underdiagnosed and under recognized by physicians on a routine basis which leads to a delay in appropriate management. The goal of this review paper is to focus on disease recognition, diagnosis and different modes of up-to-date therapies including medical management, surgical intervention, aspirin desensitization and biologic therapy.