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A 54-year-old male with chronic rhinosinusitis with nasal polyposis (CRSwNP) after sinus surgery presents for evaluation. He also has a history of adult-onset asthma that is poorly controlled, with two emergency department presentations for acute shortness of breath and wheezing in the past 6 months. Sinus symptoms began 2 years ago, with associated worsening of his intermittent wheezing and shortness of breath. He reports that both emergency room visits occurred shortly after taking nonsteroidal anti-inflammatory drugs (NSAIDs) (naproxen and ibuprofen). He also reports facial flushing and rhinorrhea when drinking red wine.
• Patient surgical history: endoscopic sinus surgery (ESS) (2 years ago)
• Current medications: nasal saline irrigations with budesonide, montelukast budesonide/formoterol, and albuterol hydrofluoroalkane (HFA)
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