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The classic ‘Samter’s Triad’ of asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and aspirin sensitivity is now referred to as aspirin-exacerbated respiratory disease (AERD) or non-steroidal anti-inflammatory-exacerbated respiratory disease. We often come across in our rhinology setting, patients with recalcitrant sinusitis who, despite maximal medical treatment and endoscopic sinus surgery, fail to achieve optimal results. Some of these patients unfortunately undergo multiple endoscopic sinus surgeries, sometimes ranging from six to 10 procedures, without significant benefit. Management can be a real challenge. In such patients, the senior author recommends that a high index of suspicion of AERD must be maintained and highlights the need for early screening for AERD and delivering appropriate management so as to reduce the patient’s morbidity. The senior author nicely outlines the management of AERD, as follows. Initial treatment of AERD should include standard asthma therapy and appropriate medical treatment of CRSwNP. For those whose sinus symptoms persist despite appropriate medical therapy, a comprehensive ESS (with consideration of upfront extended frontal sinus procedures by an experienced sinus surgeon) should be performed. All patients should be counselled regarding the risks and benefits of aspirin desensitisation (AD), which should optimally be carried out three to four weeks after ES. Biological agents should be considered in patients who fail to respond to, or are unable to, undergo ESS with or without AD. This is a nice article and of practical use for within our clinical practice.

Aspirin-Exacerbated Respiratory Disease and the Unified Airway: A Contemporary Review.
Walters BK, Hagan JB, Divekar RD.
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Sangeeta Maini

FRCS ORL-HNS, Aberdeen Royal Infirmary, Forresterhill, Aberdeen, AB25 2ZN.

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