Is it advisable to treat asthma patients with acute gallstone attacks with parenteral diclofenac (V

Fråga: Is it advisable to treat asthma patients with acute gallstone attacks with parenteral diclofenac (Voltaren)? The question relates to the problem of Aspirin Intolerant Asthma (AIA) and the possible risk to trigger an acute asthma attack by using non-steroidal-anti-inflammatory drugs (NSAIDs) in patients with diagnosed asthma.

Sammanfattning: The prevalence of aspirin intolerance in asthmatics is estimated to be 1-20 %. The severity of the reaction varies with the underlying disease. Our recommendation is therefore to thoroughly consider the patients medical history in the first place and to use NSAIDs only in patients with a history of mild and stable asthma and always under close medical supervision.

Aspirin and NSAIDs are contraindicated in patients with previously known aspirin intolerant asthma or with a medical history of unstable asthma, sinuitis, nasal polyposis and atopy.

Svar: Aspirin intolerance is a clinically distinct syndrome characterised by the precipitation of asthma attacks following the ingestion of aspirin and other NSAIDs. Aspirin intolerance is not considered to be an allergic reaction primarily mediated by antibodies. Instead, inhibition of prostaglandins, causing an imbalance of proinflammatory leukotrienes seems to be a possible explanation related to this condition. Aspirin intolerance is associated with conditions such as more severe and unstable asthma, sinuitis, nasal polyposis and atopy.<br><br>Asthma triggered by aspirin and/or NSAIDs most commonly occur within 1 hour of ingestion. The severity of the triggered attack often follows the severity of the underlying asthma in terms of number of asthma attacks, doctor visits, and self-rated asthma severity over the previous 12 months (1). Studies of aspirin intolerance in different populations indicate a prevalence ranging from 1% to 20%. In a recent study on different asthmatic populations in Australia the prevalence of respiratory symptoms triggered by aspirin was 10-11% compared to 2.5% in non-asthmatics (1-3). This observed variation in prevalence between different studies may, at least partly, be explained by differences in diagnostic criteria. Whatever the reasons may be this means that in the worst scenario up to every fifth asthmatic patient is at risk for an asthma attack with various degree of severity, upon NSAID administration. There are some case reports, which describes severe asthma attacks with lethal outcome after NSAID ingestion that cannot be neglected (4). In most cases the asthma attack is fully manageable if the patient is in hospital under close medical supervision.<div id="referenser" style="display:none;">1 Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002;57:569-74.<br>2 Knox AJ. How prevalent is aspirin induced asthma? Thorax 2002;57:565-6.<br>3 Babu KS, Salvi SS. Aspirin and asthma. Chest 2000;118:1470-6.<br>4 Drugline no 03342 (year 1982)</div>