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Aspirin-exacerbated respiratory disease — SCE Respiratory MCQ

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HardAsthmaAspirin-exacerbated respiratory diseaseSCE Respiratory

A 48-year-old man with asthma and chronic rhinosinusitis develops wheeze and nasal congestion within an hour of taking ibuprofen for back pain. He has recurrent nasal polyps and anosmia, but no urticaria. Spirometry shows variable airflow obstruction and blood eosinophils are 0.54 × 10^9/L. Aspirin challenge is deferred because of recent severe bronchospasm. What is the most likely underlying cause?

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Correct answer: A — COX-1 inhibition causing excess cysteinyl leukotriene signalling

The pattern is aspirin-exacerbated respiratory disease, in which COX-1 inhibition shifts arachidonic acid metabolism towards cysteinyl leukotrienes. IgE-mediated drug allergy is a common distractor, but the triad of asthma, nasal polyps and respiratory reactions to NSAIDs is more specific. Leukotriene receptor antagonists can help symptoms but avoidance and specialist assessment remain important.

Reference: BTS/NICE/SIGN Asthma Guideline 2024; ERS severe asthma resources