Order of Symptom Onset Associated with Diagnostic Delay in Aspirin Exacerbated Respiratory Disease (AERD)

Sunday, October 12, 2025

10:00 AM - 10:06 AM EDT

Location: 125

Disclosure(s):

Shravan Asthana, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Aspirin Exacerbated Respiratory Disease (AERD) is a unique subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP) that features asthma and aspirin (ASA)/NSAID hypersensitivity. How symptom onset order or socioenvironmental factors may be associated with diagnostic delay have not been well studied.

Methods: A retrospective study included patients diagnosed with AERD from 2005 to 2023. Diagnostic delay was defined as greater than one year from last symptom onset to AERD diagnosis by a physician. Statistical analyses included chi-square test, student’s t-test, and logistic regression.

Results: 90 patients were included with an average AERD diagnosis age of 45.89 +/- 13.73 years and were mostly female (N=53, 58.9%), White (N=63, 70.0%), and privately insured (N=72, 80.0%). 54 patients (60.0%) experienced ASA/NSAID hypersensitivity versus CRSwNP (40.0%) as their last symptom of AERD’s triad prior to diagnosis. On multivariate logistic regression, diagnostic delay was associated with increased likelihood of older age at AERD diagnosis (OR=1.04, p=0.032) and last symptom prior to diagnosis of CRSwNP (OR=7.19, p=0.001) as opposed to ASA/NSAID hypersensitivity. On sub-analysis by last symptom experienced prior to AERD diagnosis, the CRSwNP group relative to the ASA/NSAID hypersensitivity group exhibited on average a significantly higher diesel PM/m3 exposure (0.69 vs 0.60, p=0.021), younger age (years) of asthma (20.20 vs 28.17, p=0.043) and ASA/NSAID sensitivity (31.89 vs 40.50, p=0.006) onsets, and longer time from last symptom onset to AERD diagnosis (10.89 vs 3.72 years, p< 0.001).

Conclusions: Relative order of symptom onset, age at official AERD diagnosis, and environmental pollution may underlie diagnostic delay.

Presenting Author(s)

Shravan Asthana, BS

Medical Student
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Alison J. Yu, MD

Assistant Professor
Medical University of South Carolina
Charleston, SC, United States

Disclosure information not submitted.
RR

Rani Randell, BS

University of Pennsylvania, United States

Disclosure information not submitted.
MK

Michael Kohanski

Disclosure information not submitted.
James N. Palmer, MD

Professor
University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
Nithin D. Adappa, MD

Professor
University of Penn. Hosp.Dept. of Otolaryngology
Philadelphia, PA, United States

Disclosure information not submitted.
AW

Alan D. Workman, MD, MTR

Rhinology and Skull Base Surgery
Massachusetts Eye and Ear
Cambridge, MA, United States

Disclosure information not submitted.
Jennifer E. Douglas, MD

Assistant Professor
University of Pennsylvania, Department of Otorhinolaryngology - Head & Neck Surgery
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

John V. Bosso, MD

Clinical Professor
Hospital of the University of Pennsylvania
Philadelphia, PA, United States

Disclosure information not submitted.