Asthma exacerbation due to preoperative NSAID use

Background AERD (aspirin-exacerbated respiratory disease) is the combination of asthma, chronic rhinosinusitis/nasal polyposis (CRSwNP) and acute respiratory reactions after intake of NSAIDs (cyclooxygenase-1-inhibitors). It is characterized by chronic eosinophilic airway inflammation which is exacerbated by NSAIDs. Despite guideline-based treatment for asthma and CRSwNP and avoidance of NSAIDs, the disease is often progressive. Long-term aspirin treatment after desensitization can be effective. Case description A 60-year old man with a history of polyposis nasi and pansinusitis was admitted for sinus surgery. Prior to the surgery he developed hypoxemic failure after taking diclofenac. He was diagnosed with acute asthma exacerbation due to diclofenac. After treatment with oxygen, nebulized bronchodilators and prednisolone he recovered within one day. AERD was diagnosed based on patient's comorbidity and sensitivity to diclofenac. Conclusion Patients with rhinosinusitis, nasal polyps or asthma have a high risk of NSAID hypersensitivity. Therefore routinely treatment with NSAIDs should be avoided in these patients.