Has asthma/bronchospasm been reported with ASA and other NSAID? Is it dose/concentration dependent?

Fråga: Has asthma/bronchospasm been reported with ASA and other NSAID? Is it dose/concentration dependent? Can it be treated with local steroid preparations?

Sammanfattning: Asthma/bronchospasm is a well documented side effect of acetylsalicylic acid and other NSAIDs. Dose/concentration dependence of NSAID induced asthma has not been shown. Management should not differ from that ordinarily employed in acute asthmatic attacks.

Svar: Asthma/bronchospasm is a well documented side effect of acetylsalicylic acid and other NSAID and has been assessed earlier in Drugline (1-4). The reported incidence of acute bronchospasm in adult patients with asthma who take aspirin varies from two per cent to 28 per cent with similar incidence in children (5).

Mechanisms and clinical patterns of anti-inflammatory drug induced asthma have been critically reviewed by Szczeklik and Gryglewski (6). These authors hypothesize that intolerance to acetylsalicylic acid and other NSAIDs is due to inhibition of cyclooxygenase which diverts the metabolism of arachidonic acid from the formation of bronchodilatory prostaglandins, towards the production of leukotrienes, which can induce bronchospasm. According to these authors there is evidence that "the degree of enzymatic inhibition which is sufficient to precipitate bronchoconstriction is an individual hallmark (thus, if the threshold dose for any anticyclo-oxygenase drug in a particular patient is known, one can predict the threshold doses for other NSAIDs in that patient)" (6). This, however, remains to be proven. In clinical practice, one has to consider all NSAIDs in all doses contraindicated in patients with aspirin sensitivity (7).

Drug-induced asthma may be treated, if necessary by administration of adrenaline subcutaneously as the immediate treatment of choice, followed if necessary by parenteral corticosteroids, sympathomimetics or corticosteroid aerosols (1,8). The treatment of drug-induced asthma thus should not differ from the general principles of treatment of acute asthmatic attacks. Intravenous administration of hydrocortisone has in rare cases been reported to provoke bronchoconstriction in patients with aspirin induced asthma (9). The mechanism of this reaction is unknown. 1 Drugline nr 05584

2 Drugline nr 04714
3 Drugline nr 03993
4 Drugline nr 03342
5 Side effects of drugs. Ed by MNG Dukes, Elsevier, Amsterdam. 1985; Annual 9: 76-77, 81

6 Szczeklik A, Gryglewski RJ: Asthma and anti-inflammatory drugs. Mechanisms and clinical patterns. Drugs 1983; 25: 533-543 (bifogas) 7 Risk för livshotande astmareaktioner - acetylsalicylsyra och andra antiinflammatoriska analgetika. Socialstyrelsens läkemedelsavdelning 1987-05-25 8 d´Arcy, Iatrogenic diseases, 1986 9 Szczeklik A, Nizankowska E, Czerniawska-Mysik G, Sek S: Hydrocortisone and airflow impairment in aspirin-induced asthma. J Allergy Clin Immunol 1985; 76: 530-536