Dr. Angela Donaldson, a Mayo Clinic otolaryngologist, focuses her research on this condition that is difficult to diagnose.

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Coughing, wheezing, sinus pressure, the list goes on. It might describe a diagnosis that, for some, has been historically missed — aspirin-exacerbated respiratory disease.

"These are patients who have horrible asthma. They also have nasal polyps, and they're allergic to aspirin," says Dr. Donaldson.

And aspirin doesn't cause new illness. It aggravates asthma and sinus issues for these patients.

"It's a particular group of people who have been struggling with regular medical therapy that should work, and have both asthma that's difficult to control and sinus disease that’s difficult to control," says Dr. Donaldson.

She says most patients suffer for years before the correct diagnosis and treatment. And that's a focus of her research.

"How best to get people to screen for that disease process, since it's kind of overlooked multiple times, and then get people back to their normal lives," she says.

Along with aspirin, people who are affected by AERD may have problems taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Aspirin or NSAIDs may be in cold medicines and other medications, so pay close attention to labels.

Treatments may include desensitization to aspirin and NSAIDs, surgery to remove nasal polyps, and therapeutics. 

It's important to remember that a diagnosis is arduous because aspirin-exacerbated respiratory disease must include all three features of asthma, recurring nasal polyps, and problems with aspirin or NSAIDs. 

Related posts:

• Mayo Clinic Minute: Signs and symptoms of asthma
• Mayo Clinic Q and A: Understanding nasal polyps

The post Mayo Clinic Minute: Can aspirin make your breathing worse? appeared first on Mayo Clinic News Network.

The U.S. Preventive Services Task Force has issued a final recommendation on the use of aspirin in cardiovascular disease prevention. This makes it a good time to talk with your health care team about your course of treatment.

"Evidence is pointing to the fact that we're not seeing a benefit from using low-dose aspirin for reducing risk in patients who don't already have cardiovascular disease," says Dr. Demilade Adedinsewo, a Mayo Clinic cardiologist. "Further, the evidence has been pointing toward increased bleeding risk in older patients, specifically those older than 60 who take low-dose aspirin for primary prevention."

Based on research, Dr. Adedinsewo says that the task force's updated recommendation revises its previous recommendation on who should take aspirin to prevent heart disease, namely people who do not have a history of heart disease.

Dr. Adedinsewo says these are the recommendations for aspirin use:

• Patients, particularly those over 60, with no history of cardiovascular disease and who have not started a low-dose aspirin regimen for heart disease or stroke prevention, should not begin taking a low-dose aspirin without first consulting their health care team.
• Patients with documented cardiovascular disease, as well as those who have artificial heart valves or stents in their arteries, should continue their aspirin regimen, as prescribed by their health care professional. If patients are unsure if they have heart disease, they should discuss whether taking low-dose aspirin is appropriate.

Watch: Dr. Demilade Adedinsewo (pronounced DEM-eee-LAH-day Ah-day-deen-SHAY-wo) shares thoughts on the recommendations about who needs to talk aspirin.

Journalists: Broadcast-quality video sound bites with Dr. Adedinsewo are in the downloads at the end of this post. Please courtesy: "Demilade Adedinsewo, M.D. / Cardiovascular Disease/ Mayo Clinic"

Dr. Adedinsewo says the U.S. Preventive Services Task Force's guidance specifies low-dose aspirin should not be administered for primary prevention of atherosclerotic cardiovascular disease among adults 60 or older, or at any age if patients are believed to have an increased bleeding risk. Moreover, while low-dose aspirin might be considered in select, higher-risk adults 40–59, the decision to use aspirin for primary prevention of cardiovascular disease needs to be evaluated on a case-by-case basis.

"In the cardiovascular world, we've known that statins have a stronger cardiovascular benefit for primary prevention than low-dose aspirin, especially in the last three to four years with the release of three very large aspirin trial results," says Dr. Adedinsewo. "These research studies drive home the point that the benefits from low-dose aspirin were minimal to none and came at the cost of high bleeding risk."

The recommendations are based on new evidence that has been published since previous guidance was last issued in 2016. Dr. Adedinsewo says it is not unusual for guidelines to change. "Everything that we do in medicine is evidence-based, so if there are more contemporary studies, more contemporary research that provides additional, stronger evidence, the guidelines tend to move as such."

In its recommendation, the U.S. Preventive Services Task Force also calls for more research on the use of aspirin to prevent colorectal cancer.

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Generally, aspirin isn't recommended during pregnancy unless you have certain medical conditions.

This article is written by Mayo Clinic Staff. 

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Use of low-dose aspirin — 60 to 100 milligrams (mg) daily — hasn't been found to be harmful during pregnancy and is sometimes recommended for pregnant women with recurrent pregnancy loss, clotting disorders and preeclampsia.

However, use of higher doses of aspirin poses various risks depending on the stage of pregnancy. During the first trimester, use of higher doses of aspirin poses a concern for pregnancy loss and congenital defects. Taking higher doses of aspirin during the third trimester increases the risk of the premature closure of a vessel in the fetus's heart. Use of high-dose aspirin for long periods in pregnancy also increases the risk of bleeding in the brain of premature infants. If you need to take aspirin during your third trimester of pregnancy, your health care provider will likely closely monitor you and your baby.

The U.S. Food and Drug Administration (FDA) also recommends avoiding use of nonsteroidal anti-inflammatory drugs (NSAIDs) after week 19 of pregnancy, unless your health care provider advises it. Aspirin is a type of NSAID. The concern is that aspirin use could cause rare but serious kidney problems in unborn babies. This could lead to low levels of amniotic fluid surrounding a baby and possible complications.

The typical over-the-counter, low-dose aspirin is 81 mg (previously referred to as baby aspirin). If you are taking low-dose aspirin during pregnancy due to a medical condition, continue doing so as directed by your health care provider. If you need to take a pain reliever during pregnancy, talk to your health care provider about the options. He or she might suggest occasional use of acetaminophen (Tylenol, others) instead of aspirin.

Find more health and medical information on mayoclinic.org.

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Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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Are eggs and aspirin good or bad for your heart? Two recent studies may have prompted some people to wonder. One of the studies found that the more eggs you eat, the greater your risk of cardiovascular disease. The other study showed that elderly people should not take a daily dose of aspirin to reduce their risk of heart attack because the aspirin may increase their risk of gastrointestinal bleeding.

So who can eat eggs and who should take aspirin? Dr. Stephen Kopecky, a Mayo Clinic cardiologist, sets the record straight.

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He starts with eggs. It's all about moderation.

"I do think people who have high cholesterol should avoid too many eggs, but, you know, three or four a week is a reasonable amount," Dr. Kopecky says.

Egg whites are full of protein, but yolks contain a lot of cholesterol. Dr. Kopecky says if you want to eat more eggs but don't want the cholesterol, just eat the whites.

Now what about aspirin? It used to be recommended that adults at increased risk of heart attack or stroke should take aspirin to reduce their chances of having adverse events. But research shows people over 70 should not take aspirin regularly. So who should take it? Dr. Kopecky says it's all about individual risk.

"Talk to a health care provider. Have them go over your risk profile for heart attack and stroke. If your risk is really high — over about 20 percent — and you have no bleeding problems, it probably will help you, but talk to somebody about it first," Dr. Kopecky says.

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Millions of Americans are reportedly taking a daily aspirin to help prevent heart disease, and they may not need it. That's according to research published Monday in the journal Annals of Internal Medicine.

The survey found that some people are taking aspirin without recommendation from a health care provider and without having previous heart or stroke events.

The research was conducted before new guidelines were released by the American College of Cardiology and the American Heart Association in March 2019. Those guidelines said a daily aspirin is no longer recommended for older adults who don't have a high risk of or existing heart disease.

And in 2018 a study published in the New England Journal of Medicine also stated that baby aspirin isn't necessary for good health.

Mayo Clinic cardiologist Dr. Stephen Kopecky, who was not involved in either study, says, "The 2018 NEJM study showed that giving aspirin to all patients to try to reduce heart attack was not beneficial." The study included more than 19,000 people over 65 in Australia and the U.S.

"If you are taking daily aspirin, it is important to know that while your risk of heart attack goes up as you age, your risk of bleeding on aspirin goes up even more." adds Dr. Kopecky.

However, there is still evidence a daily low-dose aspirin can reduce the risk of recurrence for someone who has already had a stroke or heart attack.

Dr. Kopecky says the risk factor can be determined by using an American College of Cardiology tool that estimates the risk for atherosclerotic cardiovascular disease.

“If you have heart disease, which means that the arteries to your heart are narrowed, and don’t have a history of bleeding, then it may be helpful to be on aspirin and you should ask your health care provider about it." says Dr. Kopecky. "She or he can help provide the information needed, like cholesterol levels ... and help interpret your risk score and help you make a plan to lower it, which is primarily a change in lifestyle.”

The post Is taking a daily aspirin really necessary? appeared first on Mayo Clinic News Network.

So who can eat eggs and who should take aspirin? Dr. Stephen Kopecky, a Mayo Clinic cardiologist, sets the record straight.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Read the script.

He starts with eggs. It's all about moderation.

"I do think people who have high cholesterol should avoid too many eggs, but, you know, three or four a week is a reasonable amount," Dr. Kopecky says.

Egg whites are full of protein, but yolks contain a lot of cholesterol. Dr. Kopecky says if you want to eat more eggs but don't want the cholesterol, just eat the whites.

Now what about aspirin? It used to be recommended that adults at increased risk of heart attack or stroke should take aspirin to reduce their chances of having adverse events. But research shows people over 70 should not take aspirin regularly. So who should take it? Dr. Kopecky says it's all about individual risk.

"Talk to a health care provider. Have them go over your risk profile for heart attack and stroke. If your risk is really high — over about 20 percent — and you have no bleeding problems, it probably will help you, but talk to somebody about it first," Dr. Kopecky says.

The post Mayo Clinic Minute: Are eggs and aspirin good or bad for your heart? appeared first on Mayo Clinic News Network.

ANSWER: It depends, but you probably don’t need enteric-coated aspirin. Enteric-coated aspirin is designed to resist dissolving and being absorbed in the stomach. As such, enteric-coated aspirin passes into the small intestine, where it’s absorbed into the bloodstream. The purported goal is to prevent stomach ulcers and bleeding that can sometimes occur with aspirin use.

When it comes to preventing a heart attack or stroke, the purpose of taking low-dose aspirin is to help prevent the development of harmful — or deadly — artery-blocking blood clots. However, with enteric-coated aspirin, research indicates that bloodstream absorption may be delayed and reduced, compared to regular aspirin absorption. Regular aspirin is quickly dissolved and absorbed in the stomach. As a result, enteric-coated aspirin may not be as effective as regular aspirin at reducing blood clot risk.

Also, the gastrointestinal benefit of enteric-coated aspirin is minimal to nonexistent. When it comes to rates of ulceration and bleeding, there’s no difference between enteric-coated and regular aspirin. The risk of ulcers and bleeding probably comes from aspirin’s effects in the bloodstream, rather than from where the drug dissolves and is absorbed.

Research isn’t fully settled on every nuance of enteric-coated aspirin versus regular aspirin. Indeed, the most important factor with aspirin successfully preventing cardiovascular problems is regularly taking it at the dose recommended by your health care provider. However, the weight of evidence is on the side of taking aspirin without enteric coating to prevent harmful blood clots. If you can’t find aspirin without an enteric coating, crushing or chewing an enteric-coated aspirin eliminates the effect of the enteric coating. (adapted from Mayo Clinic Health Letter) — Dr. Brian Shapiro, Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida

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Related Articles

• Is taking a daily aspirin really necessary? published 9/17/18
• Mayo Clinic Minute: Aspirin for heart health not headaches published 5/17/18

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On the next Mayo Clinic Radio program, Dr. Sarah McCarthy, a psychologist at Mayo Clinic, will discuss how families cope with a devastating diagnosis. And Randall Mc Keeman, a child life specialist at Mayo Clinic, will explain what child life specialists do to help children and their families cope with illness. Also on the program, filmmaker Ken Burns will preview his documentary, "The Mayo Clinic: Faith, Hope, Science." Burns is the executive producer of the film, which will air Sept. 25 from 9 to 11 p.m. EDT on PBS stations. The documentary will be rebroadcast Sept. 26 from 10 p.m. to midnight EDT. And Dr. Stephen Kopecky, a cardiologist at Mayo Clinic, will answer this question: Does aspirin help prevent stroke and heart attacks?

Here's your Mayo Clinic Radio podcast.

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Jason Howland has more in this Mayo Clinic Minute.

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The old cliché is "Take two aspirin and call me in the morning." A mainstay in medicine cabinets for more than 100 years as a popular pain reliever, the take on aspirin now by health care providers is much different.

"Aspirin isn't really used anymore to treat pain," says Dr. Carrie Krieger, a clinical pharmacist at Mayo Clinic.

Instead, aspirin often is prescribed to reduce the chances of heart attack and stroke for those at high risk.

"It's an 81-milligram dose of aspirin or not more than 325 milligrams of aspirin that's recommended for certain patients and in certain cases once a day," says Dr. Summer Allen, a Mayo Clinic family physician.

The chemical makeup of aspirin creates an anti-platelet effect on the blood that keeps it from clotting. Taking too much can cause bleeding problems. And children should almost never take aspirin.

"Children can develop something called Reye's syndrome," says Dr. Krieger.

So while it might be over-the-counter, long-term use should only be doctor's orders.

"Where people run into problems is the daily and regular use of it for long periods of time," says Dr. Allen.

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