Aspirin-induced asthma

What is Aspirin-induced asthma?

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Aspirin induced asthma is characterized by aggressive and continuous inflammation of the airways leading to worsening of asthma after ingestion of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). There are many other terms for this condition, including:

ASA-induced asthma
aspirin triad
ASA sensitivity
ASA intolerant asthma
ASA-exacerbated respiratory disease

However, aspirin induced asthma has the most widespread use and acceptance in clinical medicine.As in asthma, this is a disease that occurs in the lungs.

Statistics on Aspirin-induced asthma?

The cases of aspirin induced asthma is common amongst patients with asthma as a disease.A Finland study concluded that the cases of aspirin induced shortness of breath or asthma attacks was 1.2%. Also a study from Poland concluded that the cases was 4.3% in patients with a diagnosis of asthma. In Perth, Western Australia, the prevalence of chest symptoms triggered by aspirin was 10-11% amongst patients with asthma.

Risk Factors for Aspirin-induced asthma

The predisposing factors for this disease remain vague. Age is important as the disease usually begins at 30-50 years old. However all ages can be affected.Studies have indicated the possibility of genetic risk factors for this disease.

Progression of Aspirin-induced asthma

Aspirin induced asthma develops following a characteristic sequence of events. At an average age of 30 years old, persistent rhinitis (hay fever) will appear, then followed by asthma, aspirin sensitivity and nasal polyps. The triad of asthma, aspirin sensitivity and nasal polyps are termed Samter's triad.The exact mechanism of this disease remains unknown, however continuing research has shed some light. It is thought that certain biochemical compounds in the body are either overproduced or underproduced, leading to imbalance of these compounds.This disease is thought to have an allergic component to the mechanism.

How is Aspirin-induced asthma Diagnosed?

If the patient needs to be admitted to the hospital and the disease is severe enough, routine tests will be acquired. This include looking at the blood function, liver function, kidney function, lung function, and blood electrolytes. Usually an 'arterial blood gas' will be done to assess the concentration of oxygen and carbon dioxide in the blood.

Prognosis of Aspirin-induced asthma

Aspirin induced asthma does not lead to high death rate on its own and not life-threatening. However it can lead to significant inconvenience if left untreated. Symptoms of asthma attack can be debilitating.

How is Aspirin-induced asthma Treated?

Treatment of this disease consists of the following:

NSAID avoidance: as in other allergic disease, it is important to avoid the medications known to cause the asthma attack. Aside from aspirin, other NSAIDs should bee avoided as well. NSAIDs are a group of drugs usually used as pain killers, including ibuprofen, diclofenac, etc. Although paracetamol (acetaminophen) is a generally safe substitute for pain relief, it does have weak cyclooxygenase inhibitory properties. As many as 7% of the patients who are sensitive to aspirin may react towards paracetamol if taken at high doses. Hence it is wise to avoid paracetamol as well.

Using COX-2 inhibitors: COX-2 inhibitors are drugs commonly used as pain relief as well, but slightly different from NSAIDs. current studies suggest that COX-2 inhibitors such as celecoxib do not induce asthma attack in patients with aspirin induced asthma.

Aspirin desensitization: desensitization involves using a protocol that requires 1-3 days of inpatient treatment with daily aspirin ingestion. This treatment is especially useful in patients who require aspirin or other NSAIDs regularly for pain relief, such as patients with concurrent joint condition.

Sinus disease: patients with inflammation or infection of the sinus should be treated accordingly using antibiotics. If nasal polyp is found, it should be treated accordingly too. Current research is underway regarding new treatment for this, including leukotriene modifiers such as mentelukast and zileuton.

Aspirin-induced asthma References

Eneli, I, Sadri, K, Camargo, C Jr, Barr, RG. Acetaminophen and the risk of asthma: the epidemiologic and pathophysiologic evidence. Chest 2005; 127:604.
Hedman J, Kaprio J, Poussa T, Nieminen MM. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999;28:717-22.
Kasper L, Sladek K, Duplaga M, Bochenek G, Liebhard J, Gladysz U, et al. Prevalence of asthma with aspirin hypersensitivity in the adult population of Poland. Allergy. In press 2003.
Szczeklik A. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. Allergy Clin Immunol - 01-MAY-2003; 111(5): 913-21
Up to Date: Aspirin induced asthma [online]. 2005. [Cited 2005 October 17th]. Available from: URL: http://www.utdol.com/application/topic.asp?file=asthma/10092&type=A&selectedTitle=1~7

Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin-intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002;57:569-74.