Nasal Polyposis and Nonsteroidal Anti-inflammatory Drug-Exacerbated Respiratory Disease

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) is a phenotype of nasal polyposis. The coexistence of asthma, persistent rhinosinusitis/nasal polyposis, and nonsteroidal anti-inflammatory drug hypersensitivity (NH) was formerly named as Samter’s Syndrome and is currently known as NERD. This condition should be investigated especially if the asthma is severe and/or the polyps are recurrent. There seems to be no ideal curative treatment modality for nasal polyposis. Chronic rhinosinusitis with nasal polyposis in NERD is usually more resistant to both pharmacological and surgical treatment. Long-term topical corticosteroids in adjusted doses are the first line therapy to decrease symtoms and increase quality of life. Short course of oral corticosteroids may be required. When medical therapy is inadequate for severe symptoms, sinonasal surgery should be performed in specialized ENT centers. Aspirin treatment after desensitization can be applied as a complementary treatment option in which better control of asthma symptoms and decreased need for recurrent sinus surgery have been shown. Biologicals are the promising agents mainly in severe asthma patients and may be preferred in selected patients.