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Aspirin-Induced Asthma

Medications as Asthma Triggers

By Anna Loengard, M.D.

Updated February 21, 2008

(LifeWire) - Aspirin-induced asthma – what is it? Most people don't think twice about popping an aspirin when they have a headache. But for some people with asthma, this simple remedy can be fatal.

Aspirin and other nonsteroidal anti-inflammatory drugs (also known as NSAIDS) – such as ibuprofen, naproxen and diclofenac – have been found to trigger asthma attacks in people who have asthma. The asthma attacks induced by aspirin and NSAIDS are often severe and can even be life threatening. The aspirin sensitivity appears to increase as people age, and it is worse in people with more severe asthma.

This syndrome has been recognized for many years, but it was unclear how many people with asthma faced a risk when taking these commonly used medications until studies were done on it.

A large study published in 2004 reviewed the studies done on aspirin-induced asthma (AIA for short). The researchers were surprised to find that 5% of children with asthma and 21% of adults with asthma were susceptible to AIA.

The results of this study are important because the people involved were actually "challenged" with aspirin in a controlled setting, which made for a particularly accurate estimate of how many people are affected by AIA. This way of conducting the study reduced the likelihood that people would attribute their asthma attack to the illness for which they were taking the aspirin, something the researchers concluded did happen frequently.

In fact, the investigators found that when people were asked to report prior aspirin-induced asthma attacks, the rate of positive responses was only 2.7%.

Why Does Aspirin Sometimes Cause Asthma Attacks?

Doctors and researchers initially believed that this phenomenon was an allergic response to aspirin. However, it is now believed that aspirin causes asthma attacks in some people because the aspirin acts as a deregulator of leukotrienes. Leukotrienes are substances in the body that cause inflammation and many of the symptoms in asthma.

Are There Aspirin Substitutes That Are Safe for People With AIA?

People who have AIA are also at risk for asthmatic reactions to NSAIDS, which are the medications doctors often prescribe for people who are allergic to aspirin. Studies have found that almost all people – that is, between 93% to 100% – who have AIA also have a negative reaction to NSAIDS. The likelihood of suffering an asthma attack was greater in people who reacted to even small doses of aspirin.

Patients with AIA were also tested to see how they would respond to acetaminophen (Tylenol), another common aspirin substitute. With this medication, only 7% of people with AIA had an asthmatic reaction. Again, those who were most sensitive to aspirin were more likely to react to acetaminophen as well.

Another category of pain-reliever medications, the anti-inflammatory cyclooxygenase-2 (COX-2) inhibitors such as celecoxib (Celebrex), act on a more specific anti-inflammatory pathway than aspirin and NSAIDS. Because these drugs have a narrower target in the inflammatory pathway, they do not seem to have the same effect on people with asthma.

Although COX-2 inhibitors do not have the adverse affect of inducing asthma attacks such as aspirin and NSAIDS, the COX-2 inhibitory drugs can increase the risk of heart attack and stroke. People who have AIA and who need an anti-inflammatory medication should speak with their doctor about the risks and benefits of celecoxib.

Treatment and Prevention

People with AIA tend to develop symptoms within 30 minutes to 2 hours after taking aspirin or NSAIDS, and the resulting difficulty in breathing may last for hours. The treatment is the same as that for any acute asthma attack: short-acting beta-agonist medication, and oxygen and steroids for severe symptoms.

Leukotriene modifiers are another type of asthma medication that may improve symptoms in patients who have aspirin sensitivity. Because these medications stop the actions of leukotrienes, which have been shown to play a big role in AIA, these drugs, along with inhaled steroids, should be considered for maintenance therapy for those affected by AIA.

The best way to prevent medication-induced asthma attacks is to completely avoid aspirin and NSAIDS. People who have asthma and are not sure if they have reacted to aspirin in the past should ask their doctor if it is safe to test for sensitivity to aspirin and NSAIDS. This should be done only in a controlled setting because of the risk of severe reactions.

People with known aspirin/NSAID sensitivity who need to take aspirin or anti-inflammatory medications for treatment of other conditions, such as heart disease or rheumatic diseases, are recommended to undergo aspirin desensitization. This can be done by a doctor who specializes in allergies and immunology. Once this process has been conducted, it is important that the person continue to take aspirin daily, so he will remain desensitized.

Related Articles

Sources:

"Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007." NIH Publication No. 07-4051, Aug. 2007. National Heart Lung and Blood Institute. U.S. Department of Health and Human Services, National Institutes of Health. 12 Jan. 2008 <http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf>

Gyllfors, Par, Grazyna Bochenek, John Overholt, Diane Drupka, Maria Kumlin, James Sheller, Eza Nizankowska, Peter C. Isakson, Filip Mejza, James B. Lefkowith, Sven-Erik Dahlen, Andrew Szczeklik, John J. Murray, and Barbro Dahlen. "Biochemical and Clinical Evidence that Aspirin-Intolerant Asthmatic Subjects Tolerate the Cyclooxygenase 2-Selective Analgetic Drug Celecoxib. The Journal of Allergy and Clinical Immunology (2003) 111:1116-1121. 12 Jan. 2008 <http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674903010728.pdf>

Jenkins, Christine, John Costello, Linda Hodge. "Systematic Review of Prevalence of Aspirin Induced Asthma and Its Implications for Clinical Practice." BMJ (2004) 328(7437):434. 12 Jan. 2008 <http://www.bmj.com/cgi/content/full/328/7437/434>

Macy, Eric, Jonathan A. Bernstein, Mariana C. Castells, Sandra M. Gawchik, Tak H. Lee, Russell A. Settipane, Ronald A. Simon, Jeffrey Wald, and Katharine M. Woessner. Aspirin Challenge and Desensitization for Aspirin-Exacerbated Respiratory Disease: A Practice Paper. Annals of Allergy, Asthma & Immunology (2007) 98(2):172-174. 12 Jan. 2008 (abstract) <http://puck.annallergy.org/vl=1276766/cl=18/nw=1/rpsv/cw/acaai/10811206/v98n2/s12/p172>

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Dr. Anna Loengard is a board certified, Harvard-trained internist, geriatrician and palliative medicine specialist, and an assistant clinical professor of geriatrics at the Mount Sinai School of Medicine in New York City.
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