A patient with severe eosinophilic asthma, recurrent nasal polyps and bronchospasm after ibuprofen remains symptomatic after surgery and topical treatment. What is the best overarching management?
The upper and lower airway disease and COX-1 reactions are linked; surgery alone is not disease-modifying.
A. Repeat polypectomy whenever symptoms recur: Surgery improves access and burden but recurrence is likely without inflammatory control.
B. Multidisciplinary AERD management integrating asthma, nasal inflammation and carefully selected advanced therapy: The upper and lower airway disease and COX-1 reactions are linked; surgery alone is not disease-modifying.
C. Recommend unrestricted NSAID use: Non-selective COX-1 exposure can provoke severe reactions.
D. Long-term oral steroids as the only strategy: Cumulative toxicity makes steroid-sparing management important.
E. Treat only the nose because asthma is separate: Unified-airway management is essential.
If the patient needed aspirin for cardiovascular disease, specialist desensitisation could be considered in an appropriate monitored service.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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