Do you have Nasal polyps and Asthma?

Asthma and Sinusitis: The connection is nasal polyps.

I frequently see patients with severe sinus disease (almost always with nasal polyps) who also have pretty severe asthma, requiring daily medication, usually inhaled steroids, and often oral steroids.

Many of these patients have not been told about the connection between asthma and nasal polyps or sinus disease, so let me blog about this for a few minutes.

A subset of these patients with asthma and polyps will be sensitive to aspirin and other nonsteroidal anti-inflammatory medications such as Motrin, ibuprofen, Anaprox, and Alleve.    There are dozens more anti-inflammatory drugs, most of which will be listed in a separate handouts.

In our clinic, we try to whether a patient has asthma with aspirin sensitivity or asthma without aspirin sensitivity early in the evaluation process, because this factor often substantially affects our treatment recommendations (as well as the outcomes for various possible treatments of nasal polyps).  So, if you’re evaluated in our clinic, you may be asked if you had a reaction to aspirin, Motrin, ibuprofen, or other anti-inflammatory drugs.  You may want to consider this before your evaluation are clinic, or before evaluation by any ENT surgeon.  The reaction that is of most interest to us is whether you’ve ever had an asthma attack or exacerbation of your wheezing within 20 minutes to three hours after taking any of these drugs.  Also, if you had worse nasal congestion, clear runny nose, or watery eyes after taking these drugs, you should alert your caregiver about the possibility of a reaction to aspirin.  This has a good chance of altering your treatment recommendations.

Identifying patients who are sensitive to aspirin and other anti-inflammatory drugs is very important to treat their polyps, but also can be life saving from the perspective of the patient’s asthma.  We have seen many patients who have not identified their sensitivity to aspirin and anti-inflammatory drugs and several patients who have had heart attacks or strokes due to severe allergic reactions to aspirin which the patient took because he or she was unaware of their sensitivity to the drug.

Medical treatment of patients with aspirin sensitivity and nasal polyps is often different (at least in some ways) than patients with polyps who do not have sensitivity to these anti-inflammatory drugs.  What are those differences?

  1. First, patients with aspirin sensitivity frequently have severe asthma and require multiple medications to control their asthma symptoms.  We find that most of these patients need to be on a long acting steroid inhaler or asteroid inhaler that is combined with a drug to dilate the airwaves (a bronchodilator).
  2. Second, patients with aspirin sensitivity may benefit from the addition of a pill named Singulair to improve their asthma.  Singulair is a drug designed to block the inflammatory pathway that is particularly overactive in patients with aspirin sensitive asthma.  Your ENT doctor may discuss these drugs with you if you’re not currently taking them and may work with you or your asthma doctor to consider whether these drugs are warranted in your case or whether a trial of these drugs may be warranted.
  3. Patients with aspirin and nonsteroidal drug sensitivities may respond to oral prednisone to shrink the polyps in their nose and sinuses.  Unfortunately, the effect is usually short lasting and the polyps will often (but not always) grow back rather quickly after a short burst of oral steroids has been given.  We occasionally see a patient who can take a short course of oral steroids and obtain an improvement for several months.
  4. Patients with aspirin sensitivity and nasal polyps frequently have polyps are so large that the nasal steroid spray that they inhale each day only covers a very small amount of the surface and of the polyps.  When polyps are very large and steroid sprays only cover a small were sent into the polyps, the steroid sprays don’t work particularly well.  These steroid sprays may be slowing growth the polyps, but the sprays may not be truly shrinking the polyps.  In this situation, we sometimes recommend surgery, but there are several factors that go into this consideration, most of which are brought beyond the scope of this webpage.
  5. If there is a clinical concern that a patient might possibly be aspirin sensitive, we will often have them assessed by our allergy colleagues who can perform testing for sensitivity to aspirin or other anti-inflammatory drugs.  Identification of such allergies is critical since patients may benefit from avoiding aspirin and other anti-inflammatory drugs.  In addition, identifying the sensitivity to anti-inflammatory drugs opens another treatment possibility: aspirin desensitization.

6.  Aspirin desensitization can be performed as part of the treatment for triad asthma.  There are several reports out of the Stanford University that have evaluated aspirin desensitization as a treatment option for patients with asthma, aspirin sensitivity, and nasal polyps. ( J Allergy Clin Immunol 98:751-8, 1996).  These studies have shown that a substantial number of patients who undergo aspirin desensitization have less frequent asthma exacerbations and require nasal polyps surgery less frequently.  Our experience is similar to this.  In addition, we have found that many of our patients with nasal polyps have diminished amounts of  thick, yellow, mucinous discharge and lesser amounts of clear, watery rhinorrhea if they are able to undergo the aspirin desensitization.  For more information on aspirin desensitization, follow this link on aspirin desensitization.

More on this in another post, later.  For those who are interested in learning more about Triad Asthma now, see one of my videos on YouTube

Jeff Terrell, MD

13 comments to Do you have Nasal polyps and Asthma?

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  • […] both types of nasal discharge..  These patients often times have a dramatic exacerbation of their asthma, sometimes develop a very productive cough, and worse wheezing.  When a patient with allergic mucin […]

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    • admin

      Thanks, I enjoyed reading your blog as well.
      You have a fair amount on sinusitis. I’ll read more later.
      Thanks for linking to my blog.
      I’ll look into finding out how to link to yours.

      What software do you use for your site. Its nice. Is it wordpress? If so, what template/theme? I’m assuming those are google ads on the side? Is that right?

    • admin

      Thanks, I enjoyed reading your blog as well.
      You have a fair amount on sinusitis. I’ll read more later.
      Thanks for linking to my blog.
      I’ll look into finding out how to link to yours.

      What software do you use for your site. Its nice. Is it wordpress? If so, what template/theme? I’m assuming those are google ads on the side? Is that right?

  • Having now done the same nasal polyp surgery 3 times, and each time they grow back (I have the whole AERD triad), I was excited to find out that the AERD Center at Brigham and Women’s Hospital in Boston is part of a clinical trial with a new drug. It is supposed to kill off the eosinophils (the cells) that make my nasal polyps grow back. They are looking for patients who have bad polyps on both sides and want to avoid surgery. instead I’m taking a pill twice a day for 6 months to see if the polyps shrink away without surgery. There is no fake placebo-pill, just the new drug. It has worked in more than half of the people who have tried it. still early on for me, so not sure if it is going to work for me or not, but at least they are trying! Their site is and has lots of information and links to this new trial.

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