Analgesics and asthma

Aspirin and many other analgesics may be hazardous for some patients with asthma. These patients, numbering approximately 10% to 15% of all asthmatics, have a clinical course that has been well characterized. The diagnosis is usually made from the history, but sometimes it requires analgesic challenge tests. The pathogenesis remains controversial. It appears that the analgesics responsible for the syndrome inhibit prostaglandin synthesis, and this action in turn causes the release of potent bronchoconstrictors such as SRS-A, histamine, or kinins. Usually, recognition of the syndrome and careful avoidance of prostaglandin synthesis inhibitors in affected patients are the two steps needed for effective management. Persistent symptoms, however, may require aminophylline, corticosteroids, and disodium cromoglycate as well. Recent developments may allow these patients to use substituted aspirin analogues or even aspirin itself under certain conditions. Further investigation of the prostaglandins may promote a better understanding of asthma.