How does nsaids cause asthma

The pathogenesis of chronic eosinophilic inflammation in the airway mucosa and of nasal polyps in ASA-intolerant asthmatics is not fully understood but is not related to exposure to aspirin or other NSAIDs, because simple aspirin avoidance does not improve the course of the asthma.

The latest research indicates the important role of innate immune response in N-ERD pathogenesis. It has been suggested that innate lymphoid cells ILC 2 , produced after TSLP and Il stimulation, may be a source of mediators that drive tissue eosinophilia, mucus production and bronchial remodeling in NSAIDs intolerant asthmatics Several single nucleotide polymorphisms in candidate genes coding molecules related mainly to the arachidonic acid metabolic pathway, for example, LTC4 synthase, 5-LOX, prostaglandin EP or leukotriene LT1 receptors, were found to be associated with ASA-intolerance More recently a differential gene expression profile with potent discriminative power has been reported in leukocytes of N-ERD patients Therefore, a genetic component may be important in the pathogenesis of the disease.

Although the most of these patients have a convincing history of NSAID-induced adverse reactions, in some individuals confirmation by controlled aspirin challenge is necessary.

Oral aspirin challenge is the gold standard to confirm the diagnosis. Nasal or bronchial provocation with lysine-ASA, which is available in Europe, may be a valuable alternative diagnostic tool 3. Nevertheless, oral, bronchial or intranasal challenges are time consuming and require special equipment and expertise, which is not always available.

Currently none of available in vitro methods that have been proposed to confirm NSAIDs hypersensitivity can be recommended for routine diagnosis. Although a few studies demonstrate that aspirin triggers the release of LTC4 from peripheral blood leukocytes PBL , the differences between ASA-intolerant and ASA-tolerant subjects are only quantitative and not always reproducible.

Management of asthma and rhinosinusitis in an NSAIDs-hypersensitive patient is similar to treatment of other forms of asthma and rhinosinusitis. However, there are several important additional treatment modalities to be considered when N-ERD is diagnosed 3. Therefore, ideally, the aspirin-hypersensitivity should be confirmed by a challenge test. Alternative antipyretic or analgesic drugs, such as acetaminophen less than mg given once every six to eight hours are preferred.

Selective preferential COX-2 inhibitors, such as celecoxib or valdecoxib, are tolerated by almost all aspirin-intolerant subjects. However, oral challenge tolerance test in the office is recommended to ensure that patients are able to tolerate COX-2 inhibitors. This includes one fatality following aspirin administration. Aspirin and other NSAIDs can induce bronchospasm and, in rare cases, this reaction can lead to death in aspirin-sensitive asthmatics.

A report of worsening asthma, necessitating hospital admission, following the use of NSAID ophthalmic drops serves to warn that all routes of administration can precipitate bronchospasm in sensitive asthmatics.

These symptoms resolve in a few weeks and may be followed by persistent rhinitis and the development of nasal polyps. Identification of aspirin-sensitive individuals is not merely a matter of asking whether they have experienced symptoms with a previous ingestion of NSAIDs. Ibuprofen can also worsen asthma symptoms by causing the airways to narrow in a condition known as bronchospasm.

Aspirin-induced asthma is another recognized condition, which is believed can occur with the use of other NSAIDs as well. Around 20 percent of adults with asthma will have aspirin-induced asthma. The condition is rarer in children, with around 5 percent affected.

Those who are affected after taking ibuprofen can have asthma symptoms that range from mild to severe. These symptoms can include:. Anyone who suspects these symptoms developing should tell their doctor immediately. A doctor can then decide whether or not the medicine should be changed.

People with asthma who have a peak flow meter can also check on changes in the readings after taking ibuprofen, to see if the painkiller is causing them problems. If a person with asthma has an allergic or asthmatic reaction after taking ibuprofen, they should stop taking the medication.

Those with asthma that have taken ibuprofen with no problems are at low risk of a reaction, particularly if they are more than 40 years of age. However, some people who have asthma will often not notice that ibuprofen is causing them problems until they are in their 20s or 30s. Furthermore, problems with ibuprofen use are more common in females than males. Those who do have a reaction to ibuprofen can find that it makes asthma attacks more severe and harder to control.

Second, because the medical records were retrospective, we were unable to ensure whether children with asthma had taken their prescribed NSAIDs. Third, owing to the lack of actual clinical data, we are unable to draw any conclusions on how the severity of asthma-related symptoms is associated with NSAIDs use. Finally, the lack of personal air pollution exposure data precluded an analysis of the association between individual exposure and asthma-related hospitalization.

Therefore, the aRR of asthma exacerbation for each insured region was used to determine the effects of air pollution on the asthmatic children. Traffic is the major source of air pollutants in Taipei, [ 37 ] whereas in central Taiwan, fine particles are produced primarily by thermal power plants [ 23 ] ; a higher RR was observed in the effect estimates for northern Taiwan than for central Taiwan, indicating that the type and amount of air pollutants differentially influence the risk of asthma exacerbation in children taking antiasthma medication alone and in those receiving a combination of antiasthma medication and NSAIDs in Taiwan.

Therefore, we adjusted for the insured regions in the final analysis. Secondhand smoking can also be a risk factor for asthma exacerbation [ 38 ] ; the Taiwan government prohibited smoking in public places, including schools, nurseries, restaurants, and kindergartens, since Short-term aspirin, ibuprofen, and diclofenac consumption is probably correlated with asthma exacerbation. Long-term aspirin, ibuprofen, and diclofenac consumption were not related to asthma-related hospitalization.

The authors have no conflicts of interest to disclose. Supplemental Digital Content is available for this article. National Center for Biotechnology Information , U. Journal List Medicine Baltimore v. Medicine Baltimore. Published online Oct Find articles by Jung-Nien Lai. Author information Article notes Copyright and License information Disclaimer. Published by Wolters Kluwer Health, Inc.

All rights reserved. This article has been cited by other articles in PMC. Abstract Patients allergic to aspirin or nonsteroidal anti-inflammatory drugs NSAIDs who develop respiratory reactions such as bronchospasm or asthma exacerbation have aspirin-induced asthma or NSAIDs-exacerbated respiratory disease.

Methods 2. Data resources The present research was a retrospective cohort study. Open in a separate window. Figure 1. Asthma hospitalization The start of the observation period was the first diagnosis date of asthma. Study variables Based on a previous study, [ 5 ] a series of demographic factors were selected as variables, including gender, age, insured region, classification of asthma, and comorbidity.

Table 1 Demographic characteristics of the children with asthma from to in Taiwan. Table 2 Estimated relative risk of asthma exacerbation for children in different insured regions in Taiwan from to Table 3 Asthma exacerbation resulting in asthma-related hospitalization in children with asthma in Taiwan from to Results Of the total 29, patients, 19, Table 4 Stratified hospital days and cost of asthma-related hospitalization in children with asthma from to in Taiwan.

References 1. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol ; — NSAID-exacerbated respiratory disease: a meta-analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity. Allergy ; 70 — Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice.

Bmj ; Aspirin intolerance and recurrent urticaria in normal adults and children.