Author(s)
Kerol Faltas, BA
Mark Troftgruben, Mr
Mary Ciolko, Ms
Lancelot Herpin, Mr
John Bosso, MD
Affiliation(s)
Perelman School of Medicine
Abstract:
Background: Aspirin-exacerbated respiratory disease (AERD) is an acquired inflammatory disorder characterized by asthma, eosinophilic chronic rhinosinusitis with nasal polyposis, and respiratory reactions to COX-1 inhibitors. Older adults may have distinct disease severity and treatment needs. This study evaluated disease burden and management patterns in AERD patients aged 70 years and older.
Methods: A retrospective review was conducted of patients with a clinical diagnosis of AERD who were at least 70 years old as of September 1, 2025. Data collected included demographics, aspirin desensitization status, initial and current aspirin doses, biologic use, prednisone courses, and patient-reported outcomes (SNOT-22 and ACT).
Results: Fifty seven patients (mean age 75.3 ± 3.7 years) were included. Three patients (5.3 percent) had never undergone aspirin desensitization (AD), 15 (26.3 percent) completed AD but discontinued therapy due to adverse reactions, and 39 (68.4 percent) continued daily aspirin therapy after desensitization (ATAD). Among ATAD patients, the mean initial dose was 759 ± 345 mg and the mean maintenance dose was 331 ± 132 mg. Five patients (12.8 percent) required a biologic and seven (17.9 percent) experienced asthma exacerbations requiring prednisone. Recent SNOT 22 (14.5 ± 16.8) and ACT (22.3 ± 3.5) scores indicated mild sinonasal symptoms and well controlled asthma.
Conclusion: AERD patients aged 70 years and older who remain on ATAD are typically maintained on low dose aspirin yet demonstrate favorable sinonasal and asthma control. These findings suggest that lower dose ATAD may be sufficient in older adults, supporting the consideration of lower initial desensitization dosing strategies.