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What is aspirin-exacerbated respiratory disease (AERD)?



What is aspirin-exacerbated respiratory disease (AERD)?

Diagnosis of AERD can be difficult and often takes a long time. Your health care provider most often has the ability and skills to find the problem and treat it.

Mayo Clinic Staff

Aspirin-exacerbated respiratory disease (AERD), also called Samter’s triad, has three features:

  • asthma, although only a small number of people with asthma will develop AERD.
  • Nasal polyps that often come back even after surgical removal.
  • Problems taking aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen. Be aware that aspirin or NSAIDs may be in cold medicines and other medicines.

Usually warning signs AERD don’t show up until people are in their 30s or 40s, but AERD can sometimes occur in children.

What happens when people with AERD take aspirin or NSAIDs?

Problems usually start suddenly and can be severe. Symptoms may include breathing problems, which may include worsening asthma, wheezing, coughing, sneezing, congestion, or a runny nose. Some people with AERD also have such problems if they drink alcohol, such as beer or wine.

What causes AERD?

Exact reason AERD unknown, but this is not an allergic reaction. There is no evidence that this is a genetic or hereditary disease. The disease is not caused by aspirin or NSAIDsBut AERD sinus or asthma symptoms worsen with these medications.

How to find AERD?

No special test to find AERD. There are laboratory tests that can help find the cause of your condition. There is a blood test to look for higher than normal levels of white blood cells called eosinophils. And there’s a urine test to look for elevated leukotrienes, which are chemicals that can cause airways to narrow. AERD can also affect your sense of smell. find AERD maybe if you have all three of these things: asthma, nasal polyps, and trouble breathing while taking aspirin, or NSAIDs.

When it’s not clear if you have problems taking aspirin or NSAIDs, your healthcare provider may perform an aspirin challenge called desensitization. This is done to check for the presence AERD. Your doctor and medical team give you aspirin in a safe medical environment and follow special safety procedures.

How is AERD treated? Is there a cure?

No cure for AERD, but you can prescribe several procedures, depending on your disease. A combination of treatments often works best. Options:

  • Stay away from aspirin and NSAIDsunless your healthcare provider prescribes aspirin desensitization.
  • Taking asthma medications, such as corticosteroids that you inhale.
  • Surgery to remove polyps in the nose, although they may return.
  • Taking medications such as montelukast (Singulair, zafirlukast (Acolat), or zileuton (Zyflo) to block leukotrienes.
  • The introduction of artificial proteins into your body that bind to specific purposes. These proteins, called monoclonal antibodies, try to attack the cells that are causing your problem.
  • Desensitization to aspirin. Aspirin is given in the doctor’s office in slowly increasing doses over two days. Thereafter, it is taken daily in high doses, which may help reduce the need for oral steroids. It can also prevent the recurrence of polyps in the nose.

Respiratory disease exacerbated by aspirin (AERD)


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Ask Amy: Should I help my ex-husband through his financial difficulties?



A comment

Dear Amy: My ex-husband and I divorced in 2016. We are both in our 70s and retired. We are still co-owners of our beautiful family home. Since 2020, my ex and I have been living in a house (in separate apartments).

It was mostly compatible. We have an adult son who lives nearby. He contributed greatly to the upkeep and management of the house, including renting out rooms to friends and renting out apartments to Airbnb.

My ex and I have significant stakes in the house. Our divorce agreement says that each of us is responsible for 50 percent of the costs of the house. I pay more to cover house expenses than my ex can afford to pay.

He says that they will return the money to me if we sell the house. Our divorce agreement says that either of us can demand the sale of the house, and so far neither of us has wanted to sell. We would like to leave the house to our son, but rising taxes may make it impossible to continue living here in the coming years.

My ex also owns the apartment and fought the condominium association for 10 years, leaving the apartment unoccupied and accumulating significant debt.

I am considering getting a reverse mortgage on our house to help my ex with his financial difficulties. Our son is against this idea and doesn’t want to sign a home mortgage loan (for the apartment or our house) to help my ex pay off his debts.

Our retirement income is so low that the only type of loan we could get without a guarantor is a reverse mortgage.

This situation is stressful for all of us. I have hired a financial advisor and will get her advice soon.

Any thoughts on how to move forward peacefully and at the same time solvent?

Dear Peaceful: You are wise to enlist the help of a professional financial planner. (I have little experience in complex financial or real estate transactions.)

I believe that if you are to be reimbursed for your home, then follow up carefully and get a signed agreement outlining the terms of the reimbursement.

You don’t have to mess with your ex’s apartment ownership, and you don’t have to risk a stake in your house to bail him out. A reverse mortgage makes your debt go up instead of down, simply pushing that problem into the future.

It’s mind-boggling that your ex-husband owned this empty property for so long, but it’s possible that his dispute with the condominium association led to the seizure of the property. He must get out from under this property by any means possible.

Double check your financial and legal attachment to your ex’s debt with the help of a financial planner; bring the divorce decree and any supporting documents to the meeting.

Your son seems to be very quick-witted and cautious; he should accompany you when you discuss it with a professional.

Dear Amy: I learned that my neighbor leaves her 13-year-old daughter at home alone while she goes to work on Saturdays. I’m worried about this child and wondering if I should call CPS to report this parent’s neglect?

Dear Concerned: Thirteen-year-old children are able to stay at home for several hours on their own. For many of us who were raised by single parents (or who raised our children as single parents), this turnkey life is completely normal.

A few years ago, I became curious about how this would affect children left home alone after school while their parents worked.

I asked a group of young people about this, and they all stated that they usually have a few chores that are expected of them, that their parents visit them regularly, and that the rest of the time they spend doing housework, watching TV and mostly having fun. their independence.

Obviously, there are risks for anyone who is alone in the house.

If you’re really concerned, you can offer this neighbor your phone number in case their child has any emergency needs.

Dear Amy: Sometimes I laugh when I read your answers to people. I wonder, do you realize how unintentionally funny you can be?

Dear Chakling: Sometimes when people disagree with my point of view, they claim that I am having fun, but if I add humor in response, then I do it intentionally.

In answer to your question, if I realized that I was unintentionally being funny, it wouldn’t be unintentional.

© 2023 Amy Dickinson. Distributed by content agency Tribune.

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Delta Enterprise Corp. Reminds me of a 2-in-1 children’s outdoor swing due to the risk of falling



The product’s name:

Children’s outdoor swing 2-in-1


The restraint straps on the swing seat can break, creating a fall hazard for small children.

revocation date:

March 30, 2023

remember the details


This recall includes a 2-in-1 baby swing with model numbers SW86508MM, SW86516MN, SW86575MM, SW86576MN and SW86577PW. The model number is printed on the Delta Children’s label with a blue heart at the bottom of the swing. The swing is made of plastic and has a bucket seat with three-point harnesses and a high back that has a silhouette of Mickey Mouse, Minnie Mouse or Paw Patrol on top. The swing is 16 inches wide, 10.8 inches deep and 22.2 inches high. The included rope measures 36 inches from the top of the swing. The swing is recommended for children aged 9 months to 4 years and can support up to 50 pounds.


Consumers should immediately stop using the 2 in 1 Baby Swing and contact Delta Enterprise Corp for a free belt replacement.


The firm received seven reports of swing seat belt breaks. No injuries were reported.

Sold in:

Walmart stores nationwide and online at and from March 2022 to October 2022, priced between $20 and $33.


Delta Enterprise Corp., New York

Note. Individual commissioners may have statements related to this topic. Please visit to search for approvals on this or other topics.


The US Consumer Product Safety Commission (CPSC) is responsible for protecting the public from the unreasonable risk of injury or death associated with the use of thousands of consumer products. Deaths, injuries and property damage from incidents involving consumer products cost the country more than $1 trillion annually. CPSC’s work in consumer product safety has contributed to the decline in consumer product-related injuries over the past 50 years.

Federal law prohibits any person from selling goods subject to a Commission Order or voluntary recall undertaken in consultation with the CPSC.

Life Saving Information:

Report an unsafe product

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High doses of anticoagulants help patients with COVID-19 pneumonia



High-dose prophylactic anticoagulant therapy or therapeutic anticoagulant therapy reduced de novo thrombosis in patients with COVID-19 hypoxic pneumonia based on data from 334 adults.

Patients with hypoxic pneumonia caused by COVID-19 are at increased risk of thrombosis and bleeding associated with anticoagulants, so data are needed to determine the lowest effective dose of anticoagulant, write Vincent Labbé, MD, Sorbonne University, Paris, France, and colleagues .

Previous studies of different anticoagulant strategies in patients with COVID-19 pneumonia in noncritical and critically ill patients have shown conflicting results, but some institutions recommend a high-dose regimen after evidence of macrovascular thrombosis in patients with COVID-19 treated with standard therapy. anticoagulant therapy, the authors write.

However, previously published studies have not compared the efficacy of three anticoagulant strategies: high-dose prophylactic anticoagulant therapy (HD-PA), standard dose prophylactic anticoagulant therapy (SD-PA), and therapeutic anticoagulant therapy (TA).

In an open-label trial of COVID-19 anticoagulants (ANTICOVID), published last week in JAMA Internal Medicine, The researchers identified consecutively hospitalized adults aged 18 years and older who were treated for COVID-19 hypoxic pneumonia at 23 centers in France between April 2021 and December 2021.

Patients were randomized to SD-PA (116 patients), HD-PA (111 patients), and TA (112 patients) with LMWH for 14 days or until hospital discharge or weaning from supplemental oxygen for 48 consecutive hours, whichever result comes first. HD-PA patients received a double dose of SD-PA. The mean age of the patients was 58.3 years, and approximately two-thirds of them were men; data on race and ethnicity were not collected. Participants did not have macrovascular thrombosis at baseline.

The primary outcomes were all-cause mortality and time to clinical improvement (defined as the time from randomization to a 2-point improvement on a 7-point respiratory function scale).

The secondary outcome was a combination of safety and efficacy at day 28, which included a combination of thrombosis (ischemic stroke, non-cerebrovascular arterial thrombosis, deep vein thrombosis, pulmonary thrombosis, and deep vein thrombosis associated with a central venous catheter), major bleeding, or all cause death. .

For the primary outcome, the results were similar across the groups; HD-PA did not have a significant advantage over SD-PA or TA. All-cause mortality for patients with SD-PA, HD-PA, and TA was 14%, 12%, and 13%, respectively. The time to clinical improvement for the three groups was approximately 8 days, 9 days and 8 days, respectively. Results for the main outcome were similar across all predefined subgroups.

However, HD-PA was associated with a significant four-fold reduction in the risk of de novo thrombosis compared with SD-PA (5.5% vs. 20.2%), with no observed increase in major bleeding. TA was not associated with any significant improvement in primary or secondary outcomes compared with HD-PA or SD-PA.

The current study findings of no improvement in survival or disease resolution in patients with higher doses of anticoagulant reflect data from previous studies, the investigators wrote in their discussion. “The results of our study, together with those of previous RCTs, support the suggestion that the role of microvascular thrombosis in worsening organ dysfunction may be less than suggested,” they said.

The results were limited by several factors, including open design and relatively small sample size, lack of data on microvascular (versus macrovascular) thrombosis at baseline, and the prevalence of COVID-19 delta among study participants. the researchers noted that this may have contributed to the lower mortality rate.

However, given the significant reduction in de novo thrombosis, the results support the routine use of HD-PA in patients with severe COVID-19 hypoxic pneumonia, they concluded.

Results inform current clinical practice

During the COVID-19 pandemic, “patients hospitalized with COVID-19 showed the highest risk of thromboembolic complications, especially patients in intensive care settings,” and early reports suggested that standard prophylactic doses of anticoagulant therapy may not be sufficient to prevent thrombotic events. wrote Richard S. Becker, MD, of the University of Cincinnati, Ohio, and Thomas L. Ortel, MD, of Duke University, Durham, North Carolina, in an accompanying editorial.

“Although there have been several studies that have examined the role of anticoagulant therapy in hospitalized patients with COVID-19, this is the first study that specifically compared a standard prophylactic dose of low molecular weight heparin with a “high dose.” prophylactic regimen and towards a full therapeutic dosing regimen,” Ortel said in an interview.

“Given concerns about the increased thrombotic risk with prophylactic anticoagulant doses and the potential risk of bleeding associated with full therapeutic dose of anticoagulants, this approach allowed investigators to explore the efficacy and safety of an intermediate dose between these two extremes,” he said.

In the current study, “it was notable that the main factor in improving outcomes with the ‘high-dose’ prophylactic regimen was a four-fold reduction in macrovascular thrombosis, which has not been observed in other studies of anticoagulant therapy in hospitalized patients with severe COVID-19,” Ortel told Medscape. “A lot of initial concern about disease progression in patients hospitalized with severe COVID-19 has focused on the role of microvascular thrombosis, which appears to be less important in the process, or conversely less responsive to anticoagulant therapy.”

According to Ortel, the clinical conclusion from the study is a reduced risk of venous thromboembolism with a high-dose prophylactic anticoagulant strategy compared to a standard prophylactic dose regimen for patients hospitalized with COVID-19 hypoxic pneumonia, “resulting in an improved net clinical outcome.”

Looking ahead, “more research is needed to determine whether a higher dose of prophylactic anticoagulant would be beneficial for patients hospitalized with COVID-19 pneumonia who are not in the intensive care unit,” Ortel said. Research is also needed to determine whether therapeutic interventions are equally beneficial for patients with different coronavirus variants, as most of the patients in the current study were infected with the Delta variant, he added.

The study was supported by LEO Pharma. Lead author Labbe disclosed grants from LEO Pharma during the study and fees from AOP Health not related to the current study.

Becker disclosed personal fees from Novartis DSMB, Ionis DSMB, and the Basking Biosciences Scientific Advisory Board not related to the current study. Ortel announced grants from the US National Institutes of Health, Instrumentation Laboratory, Stago and Siemens; contract fees from the US Centers for Disease Control and Prevention; and fees from UpToDate not related to the current study.

JAMA Internal Med. Published online March 22, 2023. Full text, Editorial

Heidi Splete is a freelance medical journalist with 20 years of experience.

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