Triad Asthma and Nasal Polyps

By Adem Lewis / in , , /

(lively music) – Hi, my name is Dr. Jeffrey Terrell, I’m a Otolaryngologist or
ear, nose, and throat surgeon at the University of Michigan. I see a lot of patients with
nose and sinus disorders, and today I’d like to
talk about triad asthma, which is the triad is
asthma, nasal polyps, and aspirin sensitivity. And I’ll try to make this quick, I’ve got lots of handouts that I give to patients, but let me start off
with sort of the typical history of triad asthma,
what patients complain about, what happens to them over time. And then we’ll talk a
little bit about treatment. This is a big topic and
I will not cover it all, but I think it may be helpful to people. So, triad asthma is a
disease that comes on usually in adults. People in their twenties,
thirties, forties, people that say: “I’m totally healthy and then something “happened to me”. And three things in the triad
as I mentioned before are nasal polyps, asthma,
and aspirin sensitivity. So I can talk about sort of
the average presentation, what people say, what’s
the order of these things. Most patients say they start
to get some nasal blockage. And that’s the polyps coming on. And as the polyps get a little bit larger, they block the olfactory nerves,
the sense of smell nerves, and so they’ll start to say “my sense of smell and my “ability to taste food,
to enjoy food diminishes”. So, your tongue tastes
four things, sweet, sour, salty, and bitter. But most of what you
enjoy about food actually is the sense of smell. So people say “my nose plugs
up, lost my sense of smell, “my sense of taste diminishes as well”. And then maybe six weeks, or six months, or six years later, they’ll
develop some asthma. So they’ll start coughing and wheezing. They may hear themselves
wheezing at night, or if they exercise, you go out in the cold, and then they’ll develop
asthma, most of them will go on to need
inhalers, several inhalers, oftentimes a steroid inhaler
to control the asthma. And then finally, a
month, or a year, or five years later, patients will
take aspirin for something. They got an ache or pain, or a fever. They’ll take aspirin,
or Motrin, or ibuprofen, and they will have an
allergic reaction to it where they start wheezing,
sometimes get quite shorter breaths, sometimes
end up in the emergency room. Or their nose will start
running and get all stuffy. And that is the aspirin. That’s the third thing. That’s the aspirin
sensitivity and nasal polyps. I have many patients
that come in that have asthma and nasal polyps, but they haven’t recognized they have or
they just haven’t had an aspirin, or Motrin, or non-steroidal anti-inflammatory drug allergy. And sometimes they have. And many doctors haven’t recognized or put all three together. So that’s the triad, again
it can come onto people that are entirely healthy. And we see these patients
for any number of reasons, but commonly for nasal blockage
or decreased sense of smell. And sometimes the asthma
doctors will pick it up. It turns out that people
that have severe asthma, that a fair number of
people with severe asthma, meaning they were on two or
three inhalers all year long, will develop this aspirin sensitivity. So certainly, if there’s
an asthma patient that says “I can’t breathe through my
nose” or “I can’t smell”, the majority of those
patients are going to have nasal polyps and a lot of them will have aspirin sensitivity. It’s interesting, the
aspirin sensitivity travels along with patients saying
when they drink beer or wine their nose will just drip and
get stuffy and drip as well. So that’s sort of soft call. Some of these patients will
also have clear runny nose intermittently, especially
early in the disease. The first couple years they’ll say: “I can’t lean “over and write a check because my nose “might drip unexpectedly”. And they’ll also blow
out, it sounds a little unusual, yellow rubbery mucus. And it’s mucus that’s
really sticky and yellow, it stretches almost like rubber cement. Sorry, it’s a little bit gross
but but it’s very unusual, and these patients do have that. So, we see these patients in the Department of Otolaryngology
at the University of Michigan, I see a lot of these patients. I feel privileged to work
with a group of allergists that help us manage these patients. And I’ll talk just a little
bit about how we manage them. These patients with polyps,
they do well with steroids. And when I mean steroids
there could be steroid pills, there’s steroid sprays,
there’s steroid rinses. Steroid pills will shrink
back the polyps temporarily, but we don’t want to give
a lot of steroid pills. And it’s more important
that patients be on some sort of steroid
spray or steroid rinse. So steroid pills will
shrink the polyps, but we really count on them
going on steroid, usually rinses now to keep the polyps
down at a controllable level. But many patients come in,
the polyps are quite advanced, they’re quite large, and if
we can’t control the polyps and keep their symptoms reasonable, then we offer endoscopic sinus surgery. Endoscopic sinus surgery
is done with a small scope, looking in the nose
under general anesthesia so people are totally asleep. It’s an out-patient surgery. We remove the polyps, we
open the sinuses, and open everything so it drains well. But it’s very important
after that that the patients do steroid rinses and
we show them how to do steroid rinses. If you’ve had polyp surgery
before and you haven’t been on steroid rinses,
if you have asthma, and nasal polyps, and aspirin
sensitivity and you’re not doing steroid rinses,
you should consider getting a second opinion. Most doctors are doing that now, but many haven’t recognized
that patients have asthma or aspirin sensitivity. At the University of
Michigan, we have been very fortunate to work with a
talented group of allergists, who offer another line of
treatment for these patients that have aspirin sensitivity,
asthma, nasal polyps, that have the triad asthma, and that’s aspirin desensitization. Patients will go to see them
and they can be desensitized to aspirin. That sounds strange. It’s kind of like allergy shots but not kinda like allergy shots and it turns out that you could be, a patient could be
desensitized to aspirin. And when they do that, the
polyps don’t grow back as fast. Unfortunately with
triad asthma, the polyps almost always grow back. But with steroid nasal rinses
before and after surgery, and with aspirin
desensitization, patients can make it a much longer period
of time between surgeries. Also turns out that’s
interesting, that young patients with triad asthma tend to have polyps that grow back very fast. And somewhat difficult
to control sometimes. And as patients get older,
as they have more birthdays as I say, the polyps
don’t grow back as fast, which is kind of fortunate
because some of these patients have had three or five or seven surgeries. I think it’s very important
if you have triad asthma, nasal polyps, certainly
anybody with severe asthma, nasal polyps, that you
see somebody that has some experience doing
endoscopic sinus surgery. And more importantly, managing
the patient after surgery with steroid sprays,
maybe aspirin sensitivity. And I won’t talk about some
of the new biologic drugs that are out there. There’s just been starting
to get some data about some new drugs that attack
the cells that cause polyps. But that data is still
kind of immature and I’m not prepared to talk
about that until there’s more studies that are out there. So I hope that’s been
helpful to you if you have asthma and nasal polyps,
certainly you want to know if you have aspirin sensitivity. You can actually be tested
for that by an allergist, by an experienced allergist. And if you do have triad
asthma, you want to consider some of these treatment
modalis and treatment options that we talked about. We see a lot of patients with this at the University of Michigan, and
would be delighted to help anybody that has problems,
especially in our area. Thank you. (soft music)

8 thoughts on “Triad Asthma and Nasal Polyps

  1. Lovely Video! Excuse me for the intrusion, I would appreciate your opinion. Have you thought about – Yenamilla Sniffing Reformed (probably on Google)? It is a good one off guide for curing nasal polyps permanently and naturally minus the hard work. Ive heard some pretty good things about it and my cousin after a lifetime of fighting got amazing success with it.

  2. Nice video content! Excuse me for butting in, I am interested in your thoughts. Have you tried – Yenamilla Sniffing Reformed (should be on google have a look)? It is a good one off product for curing nasal polyps permanently and naturally minus the normal expense. Ive heard some unbelievable things about it and my work buddy after many years got amazing results with it.

  3. Nice video content! Apologies for butting in, I would love your thoughts. Have you ever tried – Yenamilla Sniffing Reformed (erm, check it on google should be there)? It is an awesome one off product for curing nasal polyps permanently and naturally minus the normal expense. Ive heard some pretty good things about it and my mate at last got amazing success with it.

  4. This was great, thanks, I have been researching "signs and symptoms of sinusitis" for a while now, and I think this has helped. You ever tried – Franaar Easy Breath Formula – (just google it ) ? Ive heard some amazing things about it and my work buddy got excellent results with it.

  5. Aspirin sensitivity can also be from eating salicylate acidic foods. I have triad asthma and maintaining a low salicylate acid diet helps with the inflammation of my bronchioles and sinuses.

  6. Over 10 yrs ago I went to a doctor at a teaching hospital. My allergies and asthma were very bad. I hadn't been diagnosed with polyps at that time but he told me to stay away from aspirin and yellow dye #5. He was fitting me in so I never got to asked for a full explanation why, but I've stayed away from both just in case. No other doctor has even known why I was told this. So thank you. I actually have had 2 nasal surgeries only 3 yrs apart (they grew back extremely fast). After my 2nd surgery, at my 3 wk check up they were already coming back. My ENT had never had a patient like me before.
    I'm so glad I know that it's called triad asthma and I can explain it more thoroughly to my doctors. I have several other medical issues and I can now add this to my list.
    Thank you

  7. Useful and Good Information

    শীতে বন্ধ নাকের সমস্যার সমাধান | Nasal polyps | Respiratory system diseases

  8. I was put on low dose aspirin by my cardiologist and after about six months due to heart palpitations. I couldn't breath went to the ER and was diagnosed with nasal polyps & asthma. I'm discontinuing the aspirin.
    Actually what's humorous is that I would describe myself as "perfectly healthy," & developed heart palpitations for no real reason. In fact the exact cause cannot be determined but I was put on a selective betablocker & aspirin. Six months later I developed these symptoms.

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