Recognising the risk of aspirin-sensitive respiratory disease in a patient with asthma who has previously tolerated aspirin.

Asthma is a common chronic condition composed of numerous different phenotypes. One clinically relevant phenotype is that of aspirin-sensitive respiratory disease (ASRD) which is more frequently seen in patients with difficult asthma. Reliance on a history of previous reaction to non-steroidal anti-inflammatory drugs (NSAIDs) in order to diagnose ASRD may give false reassurance. We describe the case of a 58-year old man with late onset asthma who was suspected to have ASRD on the basis of associated clinical features despite having taken aspirin safely in the past. The diagnosis of ASRD was subsequently confirmed by an inadvertent aspirin challenge which led to a serious adverse asthma outcome.