Dr. Albert Rizzo:
So welcome back to Lungcast, the monthly respiratory health podcast series from the American Lung Association and medical news site HCP Live.com. I'm your host, Dr. Albert Rizzo, chief medical officer for the American Lung Association.
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Now, the focus of today's discussion is a bit unique. We are going to be talking to a patient and her husband, as well as a specialist in asthma and immunology, regarding a condition known as aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad.
From our specialist, we’ll learn what the Triad is, how common it is, and discuss its mechanism. Then, we’ll hear from a patient advocate regarding her experience in dealing with this condition. Like other rare or atypical conditions—or simply conditions not at the top of a physician’s mind—patients with these conditions often face delays in diagnosis, which can lead to frustration, doctor-hopping, and sometimes not achieving full therapeutic benefit. This can significantly impact quality of life.
After our patient speaks, we’ll hear from her husband, who will provide the perspective of a partner and caregiver.
To give our expert view, we have with us Dr. Mitchell Grayson, a board-certified diplomat of the American Board of Allergy and Immunology, an active fellow of the American Academy of Allergy, Asthma and Immunology, and the American College of Allergy, Asthma, and Immunology. Dr. Grayson also serves on the board of directors of the Asthma and Allergy Foundation of America and is a member of the Scientific Advisory Committee of the American Lung Association.
He has served on numerous NIH grant review study sections and several editorial boards for allergy and immunology journals. Currently, Dr. Grayson is editor-in-chief for the Annals of Allergy, Asthma & Immunology. I could think of no better person to lend expertise to today’s discussion.
Thank you very much for being with us today, Dr. Grayson.
Dr. Mitchell Grayson:
Dr. Rizzo, it’s a pleasure to be here. Thank you so much for having me. I look forward to our discussion.
Dr. Albert Rizzo:
As I mentioned, Samter’s Triad and AERD—could you please describe Samter’s Triad, maybe talk about prevalence, mechanisms, and how often it presents to clinicians? Later, we’ll hear from our patient advocate and discuss treatment.
Dr. Mitchell Grayson:
Sure. Samter’s Triad, or aspirin-exacerbated respiratory disease, consists of three main components: asthma, chronic rhinosinusitis (nasal and sinus symptoms), and nasal polyposis (growths in the nasal tissue). It’s primarily an adult-onset disease, usually developing around age 30. It often begins with nasal symptoms, then progresses to asthma, which can be severe and difficult to control.
Patients with AERD often require surgeries for nasal polyps. In adults with asthma, about 7% may have AERD. Among those with severe asthma, it’s about 14%. For adults with chronic rhinosinusitis and nasal polyps, around 16% may have AERD.
If patients with AERD take aspirin or other Cox-1 inhibitors (like ibuprofen), they can experience reactions within 20 minutes to 3 hours, sometimes leading to severe asthma attacks. The mechanism involves overproduction of leukotrienes and reduced mediators that usually regulate inflammation. Interestingly, up to 80% of people with AERD also experience worsened symptoms with alcohol.
Dr. Albert Rizzo:
That’s a great background. Now, let’s hear from the patient’s perspective. We have Ronda Nelson, a patient advocate, here with her husband Wayne Nelson.
Dr. Albert Rizzo:
Ronda, can you tell us about your initial symptoms and how AERD was eventually diagnosed?
Ronda Nelson:
In 2000, I started with what I thought was a basic cold. Returning home, symptoms lingered and worsened. Multiple doctor visits didn’t provide answers. It took over two years before I was referred to an allergist in North Carolina, who recognized the possibility of AERD. Getting the diagnosis allowed us to start proper medication and gain control over the disease.
Dr. Albert Rizzo:
And this led you to become a patient advocate?
Ronda Nelson:
Yes. I wanted to raise awareness because many people struggle to get a diagnosis or find physicians familiar with the disease. Working with the Asthma and Allergy Network allowed me to help create change and support others.
Dr. Albert Rizzo:
Have things stabilized since your diagnosis?
Ronda Nelson:
Absolutely. Over 22 years, treatments and medications have improved. I consider myself very well-maintained now, although travel and performing with my husband meant constant preparedness for emergencies.
Dr. Albert Rizzo:
Dr. Grayson, can you discuss therapy for AERD, particularly in relation to asthma phenotypes?
Dr. Mitchell Grayson:
Asthma has different phenotypes (allergic, T2-high, T2-low). AERD partially fits the T2 model due to leukotrienes, but sensitivity to Cox-1 inhibitors is unique. Treatments include standard asthma therapies, biologics like omalizumab, mepolizumab, dupilumab, and aspirin desensitization. Biologics can reduce nasal polyps and control asthma. Aspirin desensitization involves gradually increasing aspirin doses under medical supervision, improving tolerance and airway disease, but nasal polyps may require surgery first.
Dr. Albert Rizzo:
Ronda, how has day-to-day management been for you?
Ronda Nelson:
Thanks to my medical team and biologics, I’m well-maintained. I’ve also incorporated complementary therapies like acupuncture, low omega-3 diet, red light therapy, supplements, and regular exercise—but always with physician guidance.
Dr. Albert Rizzo:
Wayne, can you share your perspective as a caregiver?
Wayne Nelson:
It’s been challenging. Watching your loved one have severe reactions, sometimes needing emergency care in the middle of the night, requires patience and constant vigilance. Touring with a band added complexity, but preparation was key. It’s exhausting, but support and advocacy are crucial.
Dr. Albert Rizzo:
Any final advice from your advocacy standpoint?
Ronda Nelson:
Keep a medical journal documenting symptoms and experiences. It helps physicians piece together a diagnosis. Discuss new treatments with your doctor and advocate for yourself, as what works for one patient may not work for another.
Dr. Mitchell Grayson:
I echo that. Share all your symptoms with your provider and actively participate in decision-making. Treatments have advanced significantly, so there is hope. Don’t give up.
Dr. Albert Rizzo:
Thank you, Dr. Grayson, Ronda, and Wayne Nelson, for sharing your experiences and insights on AERD. To our listeners, subscribe to Lungcast and visit lung.org for more news and resources.
Until next time, I’m Dr. Albert Rizzo, reminding you: if you can’t breathe, nothing else matters.
