Aspirin Exacerbated Respiratory Disease (AERD) and Asthma Survey



Race

Sex


10 or less
11 to 20
21 to 30
31 to 40
41 to 50
51 to 60
Over 60
Not applicable
10 or less
11 to 20
21 to 30
31 to 40
41 to 50
51 to 60
Over 60
Not applicable


If yes, which one:




If yes, which one:









































0 or Not Applicable







































10 or less
11 to 20
21 to 30
31 to 40
41 to 50
51 to 60
Over 60
Not applicable

















28. For each of the following medicines, indicate if currently or previously used.
Then rate effectivenss from "1" (not at all effective) to 10 (extremely effective).
Use: Effectiveness
(scale 1-10):
Nasal saline rinse      
Budesonide nasal rinses      
Steroid nasal sprays
(E.g. Fluticasone (Flonase, Aller-Flo),
Budesonide (Rhinocort),
Triamcinolone (Nasacort))
     
Antibiotic nasal sprays      
Montelukast (Singulair)      
Zileuton (Zyflo)      
Steroid inhaler
(E.g. Flovent, Arnuity, Asmanex, Pulmicort, Qvar)
     
Combination inhaler with steroids
(E.g Advair, Symbicort, Dulera, Breo)
     
Ipratropium inhaler (E.g Spiriva)      
Daily steroid pills (E.g. prednisone, methylprednisolone (medrol))      
Omalizumab (Xolair) injections      
Mepolizumab (Nucala) injections      
Reslizumab (CinqAir) injections      
Benralizumab (Fasenra) injections      
Dupilumab (Dupixent) injections      
Prolonged courses of antibiotics      
Bronchial thermoplasty      
Allergy "injections" (i.e. desensitiztion therapy)      
Aspirin therapy