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Related Experiment Videos

[Asthma and aspirin].

Michele Schiappoli1, Federica Gani, Francesco Frati

  • 1Unità Operativa di Allergologia, Ospedale Civile Maggiore, Verona.

Recenti Progressi in Medicina
|August 12, 2003
PubMed
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Aspirin-induced asthma (AIA) is a significant condition, particularly in asthmatics, often starting with rhinitis and progressing to severe asthma. Management involves avoiding aspirin and similar NSAIDs, with antileukotrienes and steroids being effective treatments.

Area of Science:

  • Immunology
  • Pulmonology
  • Pharmacology

Background:

  • Aspirin-induced asthma (AIA) is a distinct clinical entity affecting up to 21% of asthmatics.
  • The condition often initiates as non-allergic rhinitis, potentially with nasal polyps, and progresses to severe asthma requiring oral corticosteroids.
  • AIA persists irrespective of continued aspirin intake and predominantly affects middle-aged females.

Purpose of the Study:

  • To elucidate the pathogenesis of aspirin-induced asthma.
  • To review diagnostic approaches, including the role and safety of challenge tests.
  • To discuss current and potential therapeutic strategies for AIA management.

Main Methods:

  • Review of existing literature on aspirin-induced asthma.
  • Analysis of the role of arachidonic acid metabolism in AIA pathogenesis.

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  • Evaluation of diagnostic methods like clinical history and provocation tests.
  • Assessment of treatment options including NSAID avoidance, corticosteroids, antileukotrienes, and desensitization.

    • Main Results:

    • Aspirin's inhibition of cyclo-oxygenase (COX) shifts arachidonic acid metabolism towards leukotriene synthesis via lipoxygenase.
    • ASA-intolerant patients exhibit enhanced leukotriene synthesis due to activated LTC4 synthetase.
    • Clinical history is crucial for diagnosis, with nasal challenge tests being safer but requiring standardization.

    Conclusions:

    • Aspirin-induced asthma involves complex alterations in inflammatory mediator pathways.
    • Careful patient selection and avoidance of NSAIDs with similar mechanisms are key; COX-2 inhibitors are generally safe.
    • Antileukotrienes, in conjunction with steroids, are beneficial for asthma control, and desensitization is an option for select individuals.