GI Disorders Nasal Health Polyps

An aspirin a day can keep the polyps at bay

Dr. Andrew Thamboo (L) and Dr. Juan Ruiz use aspirin to treat patients at the AERD Clinic, a pilot project at St. Paul's Hospital.

When we think of innovation in health care, we often think of ground-breaking genetic research or sophisticated new surgical techniques. But sometimes innovation is bringing a simple and cost-effective treatment to an underserved group of patients.

That’s what Dr. Juan Ruiz, an allergist, and Dr. Andrew Thamboo, a rhinologist specializing in nose and sinus care, are doing with their pilot project, the Aspirin Exacerbated Respiratory Disease (AERD) Clinic at St. Paul’s Hospital. The clinic helps patients who are experiencing severe symptoms from AERD, also called Samter’s Triad.

An underdiagnosed and undertreated disease

AERD is a complex condition where patients live with asthma, severe nasal and sinus polyps, and a respiratory reaction to aspirin and other nonsteroidal anti-inflammatory drugs. Many people who have AERD don’t even know it. Those who have been diagnosed often receive fragmented care from allergists, ear nose and throat specialists, and surgeons. Treatment can include multiple surgeries to remove polyps, corticosteroid medications, effective but with significant side effects, or expensive biologic medications that can be difficult to access.

Drs. Ruiz and Thamboo established the pilot AERD Clinic in November 2021. The clinic offers aspirin desensitization therapy, a process where people with AERD are given several small doses of aspirin over the course of a day. The patients are closely supervised by the medical team in case of any adverse effects. Once they leave the clinic, patients continue to take small daily doses of aspirin to maintain the desensitization.

“We are the first in BC to offer this service, based on protocols used at many hospitals in the United States,” says Ruiz. “It seems counterintuitive, but if you give a person with AERD small doses of aspirin over one or two days, their polyps stop growing, their asthma improves, and they have much less congestion.”

In the past decade, only two or three people in BC received aspirin desensitization therapy as it was challenging to do safely in a doctor’s office. Since the clinic opened, seven people have received the treatment.

Simple treatment life changing for patients

This seemingly simple treatment has been a game changer for people like Mohamed Ibshara. He had been living with AERD for years before he was finally diagnosed in 2017.

“My asthma was so bad I was waking up during the night to take my inhalers. The polyps kept growing, even after surgery. By 2021, they’d got so bad, they were pressing against my eye and I almost lost my vision,” Ibshara recalls. “I had surgery again and aspirin desensitization therapy in March and it’s changed everything.”

Mohamed Ibshara lived with AERD for years before finally getting proper diagnosis and treatment.

Ibshara loves to cook and eat so he was thrilled to regain his sense of taste and smell following his procedure. He’s back to playing soccer with his friends and instead of stopping every 15 minutes to use his inhaler, he can play right through the game. In fact, his asthma has improved so dramatically, he’s managing it with just one dose of medication a week.

The power of collaborative care

The pilot AERD Clinic is also working to improve the coordination of care for people living with AERD and other complex sinus and allergic diseases. It allows patients to access coordinated care delivered by a multidisciplinary team, instead of being seen separately by various specialists.

“People don’t realize how complex it is to do collaborative care – our current health system isn’t set up to support it,” says Thamboo. “As a surgeon, I only see the surgical side. Working with a medical doctor like Dr. Ruiz helps me see other aspects of the case and how we can work together to create a personalized care plan for our patients.”

Like Ibshara, Lucas Schmidt is also grateful for the treatment he received at the AERD Clinic.

“I’d been living with chronic sinusitis for six years and I’d already had surgery to remove polyps from my nose and sinuses. When I was referred to Dr. Thamboo, I was looking for a long-term solution,” says Schmidt. “Dr Thamboo and Dr. Ruiz suggested a combination of surgery and aspirin desensitization therapy.”

Schimdt had surgery to remove polyps in July and aspirin desensitization in September.

Lucas Schimdt  hiking on Vancouver Island after nasal surgery with Dr. Thamboo.

“I have so much more peace of mind since this procedure. I don’t have to use saline rinses or inhalers all the time. I hiked the North Coast Trail near Port Hardy  this summer and I plan to go snowboarding much more often this winter,” says Schmidt. “Taking a daily aspirin is an easy way to manage my AERD.”

Ongoing innovation through research

The clinic  recently received a boost when it obtained additional funding from the Department of Medicine’s Innovation Platform, designed to help department members develop and implement innovative and transformational projects that are aligned with the PHC strategic plan as well as the new St. Paul’s Hospital redevelopment plan. The funding will allow the pilot project to operate for another two years and gather additional data to prove its value to patients and to the health-care system.

In addition to their collaborative model, Ruiz and Thamboo are bringing innovation to the care of people with AERD in other ways. Ruiz is using computer algorithms to analyze data collected on patients with AERD to find patterns that will help doctors understand the disease better.  Thamboo is creating a biobank of tissues and blood samples from patients. The goal is to better understand who will benefit most from surgery, aspirin desensitization or biologics. It will allow physicians to create highly personalized treatments for patients.   

Story by Lori Last