Why Asthma Sufferers Should Avoid Aspirin and NSAIDs

Between five and 10 percent of people with asthma are sensitive to aspirin and nasal polyps. This condition is called asthmatic aspirin intolerance and the results of taking an aspirin or similar medication can be dramatic, or even fatal.

Key takeaways:
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    Regarding the monitoring of asthma signs and symptoms, patients should be taught to recognize inadequate asthma control, and providers should assess control at each visit.
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    Early diagnosis of aspirin sensitivity is essential in sensitive populations and should be required to prevent severe respiratory reactions among vulnerable populations.
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    The six most common potential NSAIDS in addition to aspirin are: ibuprofen, diclofenac, mefenamic acid, naproxen, ketoprofen, and flurbiprofen.
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    Beware of the use of ibuprofen as it has stronger analgesic effects than acetaminophen and is often prescribed for the treatment of fever or relieving pain in children in the US.
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    To monitor pulmonary function, regularly perform pulmonary (spirometry and peak-flow) monitoring.
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    For the quality of life and functional status, inquire about missed work or school days, reduction in activities, sleep disturbances, or change in caregiver activities.

A single dose of aspirin can provoke an acute asthma attack, accompanied by a runny nose (rhinorrhea), eye irritation (conjunctival irritation), and flushing of the head and neck region. It can also occur with other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.

Asthma patients who are susceptible to NSAIDs can also develop respiratory reactions such as bronchospasm where the muscles that line the bronchi or airways in the lungs tighten. The result is wheezing, coughing, and difficulty in catching your breath. Left untreated, severe bronchospasm can be life-threatening.

What are the signs and symptoms of asthma and how is it diagnosed?

Signs and symptoms of asthma include the following:

  • Wheezing
  • Coughing
  • Shortness of breath
  • Chest tightness/pain

A detailed assessment of the medical history should address the following:

  • Whether symptoms are attributable to asthma
  • Whether findings support the likelihood of asthma (eg, family history)
  • Asthma severity
  • Identification of possible precipitating factors

Family history may be pertinent for asthma, allergy, sinusitis, rhinitis, eczema, and nasal polyps. The social history may include home characteristics, smoking, workplace or school environment, education level, employment, social support, illicit drug use, and other factors that may contribute to non-adherence to asthma medications.

The patient’s exacerbation history is important concerning the following:

  • Usual illness onset signs or symptoms
  • Rapidity of onset
  • Associated illnesses
  • Number in the last year
  • Need for emergency department visits, hospitalizations, ICU admissions, intubations
  • Missed days from work or school or activity limitation

What do NSAIDs or aspirin have to do with asthma?

The bottom line is that some asthma patients are allergic to NSAIDs, specifically aspirin. It is important to understand that even if your child is not given aspirin, they may have an aspirin sensitivity, which includes NSAIDs and asthma.

Aspirin or NSAIDs work by inhibiting an enzyme in our body called cyclooxygenase (COX) and reducing prostaglandin synthesis, a group of lipids made at sites of tissue damage or infection that participate in our body handling injury or infection. That is how aspirin or NSAIDs act to reduce fever and relieve pain and inflammation.

However, inhibition of the COX pathway activates other enzymes called lipoxygenase leukotrienes and elevates the risk of bronchospasms or asthma exacerbation.

Currently, aspirin is not recommended for children under 12 years of age because of the potentially severe side effects including Reye syndrome. Reye syndrome is a rare, but serious condition that can cause swelling in the liver and brain. It is often seen in children who are recovering from a viral infection such as the flu or chickenpox. A small dose (less than 45 mg/kg) of aspirin can increase the risk of Reye syndrome as much as 20 times.

For children with asthma, NSAIDs must be given with caution as there is a risk of asthma exacerbation. In general, NSAIDs can induce bronchospasm within 30 to 180 minutes or sometimes as long as 24 hours later after drug ingestion.

How is asthma treated?

For all patients, except for the most severely affected, the ultimate goal is to prevent symptoms, minimize morbidity for acute episodes, and prevent functional and psychological morbidity to provide a healthy, or as healthy as possible, a lifestyle that is age-appropriate for the child.

Asthma is treated in a stepwise approach using current medical guidelines. The treatment is broken into age groups: 0 to 4 years, 5 to 11 years, and 12 years and older.

Allergy and environmental controls are an essential part of treatment. This means avoidance of irritants such as dust mites, animals, cockroaches, mold, pollen, and medications such as aspirin or NSAIDs in particular patients.

Allergy testing or skin testing can play a key role in the workup of an asthma patient. Some healthcare providers use blood tests for allergies instead and they can be highly accurate and beneficial.

The blood test is called blood radioallergosorbent tests (RASTs). These blood tests can evaluate aspirin sensitivity. Traditionally, aspirin challenge tests were given to children to determine their aspirin sensitivity and the blood tests may be safer in many cases.

Likewise, allergen-inhalation challenges such as exposure to pet dander or dust can be attempted like a trial of aspirin. Again, these challenges today are not recommended or needed in most cases.

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