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 1-inhibiting nonsteroidal anti-inflammatory drugs. N-ERD has a high disease burden and is estimated to affect 7% of adults with asthma and 30% of patients who have both asthma and nasal polyps. The disease is underdiagnosed and underrecognized by physicians on a routine basis, which leads to a delay in appropriate management. The goal of this review is to focus on the disease recognition, diagnosis, and different modes of up-to-date therapies, including medical management, surgical intervention, aspirin desensitization, and biologic therapy.