Oral Steroids for AERD (Samter's Triad)

An Unfortunate Reality

Aspirin Exacerbated Respiratory Disease is often unable to be controlled by topical or inhaled corticosteroid medications. Many AERD (Samter's Triad) patients are reliant on systemic oral steroids to maintain our quality of life. One study found that 51% of AERD patients required chronic systemic corticosteroid therapy at an average dose of 8mg prednisone per day. Those of us who do not take daily prednisone frequently require short 'bursts.'

Oral steroids are powerful medications that pose significant risks, particularly when used at high doses or for long periods of time. In general, patients and doctors try everything possible to keep oral steroid use to a minimum. Many studies have shown that most patients who get desensitized to aspirin are able to reduce their use of oral steroid medications.

Burst Therapy

A 'burst' of prednisone is often used to treat exacerbations of both asthma and nasal polyp symptoms. This involves taking systemic steroids, like prednisone, at high doses for a brief period of time to quickly bring symptoms under control. Bursts generally last 3-14 days and involve slowly reducing the amount of medication (tapering) to reduce the potential for side effects. Unfortunately, for most AERD patients, symptoms resume as soon as prednisone is discontinued.

NEVER SUDDENLY STOP TAKING AN ORAL STEROID MEDICATION.

Maintenance Therapy

Systemic steroid medications may also be given in a low dose daily or every other day for long-term control of symptoms. Doses less than 7.5 mg per day are generally considered physiologic, meaning comparable to what the body produces naturally and less likely to produce severe side effects. Some AERD/Samter's Triad patients are able to maintain their sense of smell and quality of life with low dose prednisone. Alternate day therapy may further reduce the risk of side effects. Long term steroid use should only be considered when other medical therapies have failed, as there are still risks associated with long term use. 

Risks

Prednisone often feels like a magic cure for AERD (Samter's Triad) patients, but it is important to weigh the risks versus the benefits. Oral steroids are systemic medications, which means that they can have more significant side effects than either inhaled or topical steroid medications. The likelihood of serious side effects depends on dose and length of use. In general, greater side effects are experienced by those taking high doses for extended periods of time.