How can nsaids cause asthma

In another study 6 weeks of treatment with zileuton in patients with N-ERD resulted in improvement in pulmonary function, although the magnitude of improvement did not exceed that observed in NSAIDs-tolerant patients in other studies Available data indicate that although ALDs may be effective in relieving symptoms and improving respiratory function in some patients with N-ERD the degree of improvement is similar in ASA- sensitive and tolerant asthmatics.

Anti-IgE treatment and biologicals targeting eosinophilic inflammation mepolizumab, reslizumab, benralizumab, dupilumab seem to be promising therapeutic option in N-ERD patients, especially in difficult to treat asthmatics.

Recent studies prove the effectiveness of biological drugs in reducing symptoms from the upper and lower respiratory tract in a proportion of N-ERD patients 27, 28, Desensitization can be also achieved silently, for instance, without evoking initial adverse reaction providing the challenge starts with a sub threshold dose and then the dose is slowly increased in appropriate intervals In order to maintain the tolerance a patient has to ingest aspirin on regular, usually daily basis — the tolerance state disappears after days without aspirin with the full hypersensitivity returning after 7 days.

Several protocols of desensitization have been proposed allowing for completing the procedure usually within 3 to 5 days. The standard protocol of desensitization is an extension of the oral aspirin challenge protocol and all the safety precautions recommended for the challenge should be employed 3. ATAD results in alleviation of chronic upper and lower airway symptoms The effectiveness of this treatment has been proven in many observational and placebo — controlled studies In some patients, significant improvement in nasal and asthma symptoms and reduction in the dose or even discontinuation of oral steroids were already observed 31 within the first four weeks of treatment with aspirin.

The clinical benefit is usually seen within the first 6 months of desensitization and continues to be effective for up to 5 years of follow-up. For greater effectiveness it has been suggested to combine ATAD with extensive nasal endoscopic surgery, starting aspirin desensitization two to six week after surgical intervention ATAD may be associated with adverse effects including gastrointestinal irritation, rush, urticaria epistaxis and worsening of nasal or bronchial symptoms Since gastrointestinal side effects are the most common, in order to prevent adverse effects of ATAD appropriate measures eradication of Helicobacter pylori before aspirin therapy, and drugs like PPI and H2-blokers should be administered 3.

Considering these limitations, only a fraction of patients with N-ERD will benefit from aspirin desensitization, and at present it is not possible to identify these patients before the procedure is implemented. Aspirin given after desensitization may be also a valuable solution for NSAIDs-hypersensitive patients requiring chronic treatment with aspirin for coronary heart disease or rheumatoid diseases Desensitization can also be achieved after repeated intranasal application of lysine aspirin It has been reported that intranasal desensitization and prolonged treatment with soluble intranasal aspirin Lysine-aspirin has a beneficial effect on CRS, reducing recurrence rate for nasal polyps in ASA-treated groups as compared to placebo treated patients Patients with N-ERD require comprehensive diagnostic and therapeutic approaches and pose a significant challenge for an allergist.

N-ERD has been considered a distinct phenotype of bronchial asthma characterized by increased risk of uncontrolled upper and lower airway disease, however, recent data suggest existence of N-ERD sub-phenotypes or even sub endotypes.

These new observations may explain the heterogeneity in the responses to various treatment modalities e. Acetaminophen, meloxicam, nimesulide, selective COX-2 inhibitors celecoxib, rofecoxib. This site uses cookies. To October , the Centre for Adverse Reactions Monitoring had 81 reports of bronchospasm following the ingestion of non-steroidal anti-inflammatory drugs NSAIDs and 6 reports of exacerbation of asthma symptoms.

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. This does not exclude the possibility of a reaction as many patients may have had NSAIDs in the past with no ill-effect. The children were classified into 1 of 7 regions on the basis of their insured region: Taipei City, Kaohsiung City, northern Taiwan, central Taiwan, eastern Taiwan, southern Taiwan, and outlying islands.

Each of these regions has different levels of air pollution. In addition, the model was stratified by the duration and cost i. Estimated relative risk of asthma exacerbation for children in different insured regions in Taiwan from to Asthma exacerbation resulting in asthma-related hospitalization in children with asthma in Taiwan from to All NSAID prescription records were obtained from outpatient visit records, and the logistic regression model was used to calculate the adjusted odds ratio aOR.

All statistical analyses were performed using SAS version 9. Of the total 29, patients, 19, By the end of the study period, patients 6. Consistent with previous studies, [ 28 , 29 ] the prevalence of asthma was higher in boys The highest density of children with asthma was found in Taipei and northern Taiwan, accounting for Furthermore, atopic asthma accounts for approximately a quarter of patients with asthma Allergic rhinitis, observed in up to There was no significant difference in the demographic characteristics between the 2 groups.

The index group had a higher RR of asthma-related hospitalization RR: 1. Stratified hospital days and cost of asthma-related hospitalization in children with asthma from to in Taiwan. After adjustment for sex, age, insured region, asthma classification, number of comorbidities, and type of antiasthmatic agent, ibuprofen had the highest usage rate in 1 to 2 days before asthma-related hospital admission.

Compared with the reference group, the index group had a higher percentage of exposure to ibuprofen, diclofenac, in 1 to 2 days before asthma-related hospital admission ibuprofen: aOR: 3. Compared with other NSAIDs, patients with cumulative exposure to diclofenac, aspirin, and ketoprofen were at a nonsignificantly higher risk of asthma-related hospitalization.

Numerous problems are associated with asthma when conventional antiasthma medicines—which decrease resistance in the respiratory airway and increase airflow to the lungs—and NSAIDs—which may cause bronchospasms—are taken simultaneously by children with asthma, resulting in an unpredictable outcome for asthma control. This study demonstrates that NSAIDs use was associated with an increased risk of asthma exacerbation.

In general, NSAID-induced bronchospasm develops within 30 to minutes sometimes up to 24 hours after drug ingestion, [ 30 ] possibly precipitating the asthma exacerbation. To examine the short-term effects of NSAIDs on asthma exacerbation, we analyzed the population hospitalized for asthma and defined the NSAID exposure time 1 to 2 days before hospitalization as our assessment point. During the study period, children with asthma were exposed to aspirin, and 9 of them developed an acute asthma exacerbation within 48 hours after aspirin use.

Therefore, it can be inferred that the incidence of AIA among children with asthma in Taiwan was approximately 3. It is not surprising that the prevalence rate of AIA based on aspirin provocation tests is higher than that based on the requirement for hospital admission.

Both physicians and parents should be aware of the association between the concurrent use of antiasthmatic agents and aspirin and potential risk of acute asthma exacerbation in children with asthma. Therefore, early diagnosis is essential in sensitive populations, and further management is required to prevent severe AIA exacerbation among vulnerable patients with asthma in Taiwan. In addition, the study results demonstrate that ibuprofen, diclofenac, mefenamic acid, naproxen, ketoprofen, and flurbiprofen were the 6 most prescribed NSAIDs for relieving pain or fever-like symptoms among children with asthma in Taiwan, and short-term use of ibuprofen and diclofenac increases the risk of asthma-related hospitalization.

Because ibuprofen has stronger analgesic effects than does acetaminophen, [ 31 ] it has been the most frequently prescribed for treating fever or relieving pain in children. To our knowledge, this is one of the first observational studies to prove that the risk of asthma exacerbation is associated with the short use of NSAIDs in children whose asthma is under control. This study urges the physicians to reassess their treatment strategies for fever in children with asthma. In addition, further research on optimal treatments and the long-term outcomes of NSAID-induced asthma exacerbation are warranted.

The present study has 4 limitations. However, because the NHI system covers all prescriptions by qualified physicians after careful examinations, providing affordable, accessible, and convenient asthma healthcare, the likelihood of parents purchasing over-the-counter NSAIDs is not high. 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.

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