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Aspirin-exacerbated respiratory disease — SCE Respiratory MCQ

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ModerateAsthmaAspirin-exacerbated respiratory diseaseSCE Respiratory

A 29-year-old woman has recurrent wheeze, chronic rhinosinusitis and two ED attendances after taking ibuprofen. Spirometry shows reversible airflow obstruction and nasal endoscopy shows bilateral polyps. Blood eosinophils are 0.55 x 10^9/L. What is the most likely underlying cause?

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Correct answer: B — Cyclo-oxygenase-1 inhibitor sensitivity with leukotriene overproduction

Asthma, nasal polyps and respiratory reactions to non-steroidal anti-inflammatory drugs are characteristic of aspirin-exacerbated respiratory disease. Occupational asthma would require a work-linked exposure pattern, and alpha-1 antitrypsin deficiency would not explain NSAID-triggered bronchospasm with polyposis. The teaching point is to avoid non-selective NSAIDs and optimise asthma and upper-airway disease.

Reference: BTS/NICE/SIGN Asthma Guideline 2024; BNF