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Aspirin-exacerbated respiratory disease — SCE Respiratory MCQ

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HardAsthmaAspirin-exacerbated respiratory diseaseSCE Respiratory

A 29-year-old woman attends after two emergency admissions for acute asthma following ibuprofen use for migraine. She has chronic rhinosinusitis, nasal polyps and persistent smell loss. Baseline spirometry shows reversible airflow obstruction and blood eosinophils are 0.54 x 10^9/L. What is the most likely underlying cause?

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Correct answer: B — Aspirin-exacerbated respiratory disease due to dysregulated leukotriene pathways

Asthma, nasal polyposis and respiratory reactions to NSAIDs indicate aspirin-exacerbated respiratory disease, driven by altered arachidonic acid metabolism and leukotriene excess. IgE food allergy, vocal cord dysfunction and ciliary disease do not explain the reproducible NSAID association with polyps and eosinophilic asthma. Alpha-1 antitrypsin deficiency causes emphysema rather than this upper and lower airway inflammatory syndrome.

Reference: BTS/NICE/SIGN Asthma Guideline NG245; BNF