Oral Steroids for AERD (Samter's Triad)
An Unfortunate Reality
Aspirin Exacerbated Respiratory Disease is sometimes unable to be controlled by topical or inhaled corticosteroid medications. Some AERD patients are reliant on systemic oral steroids to maintain our quality of life. 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. Studies have shown that most patients who get desensitized to aspirin are able to reduce their use of oral steroid medications. There are a variety of other medications that can also help patients rely less on oral steroids, including anti-leukotriene medications like Singulair and Zyflo, biologic medications like Dupixent, and effective nasal steroids such as budesonide rinses or Xhance.
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.
Systemic steroid medications like prednisone may be given in a low dose daily or every other day for long-term control of symptoms. Some AERD patients are able to maintain their sense of smell and quality of life with low dose prednisone. Long term steroid use is generally only considered when other medical therapies have failed, because there are risks associated with long term use.
Prednisone often feels like a magic cure for AERD 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. There are other treatments that are able to reduce oral steroid use for most patients including aspirin desensitization, anti-leukotriene medications, and biologic medications.