Aspirin and NSAID Sensitivity and Asthma

Yesterday, I tweaked my knee and there returned the familiar ouch of knee pain. I have had several sport injuries in the past and while this isn’t the worst knee injury. I did have significant thoughts I should take something for pain relief and with a call in to my specialist in the morning for evaluation. I have a knack for injuries on holidays or weekends. I have been meaning to follow up on an injury that I had earlier in the fall. There came the question of the evening, which one of the pain meds was it that may interfere with my asthma? Since I do not often have pain for any reason and I seldom take things for pain relief. I could not really remember which was better. I was going to need to reference my medical journal. I try and keep as detailed notes after appointments and tracking changes in my asthma status and other health issues.
I know that I certainly have been questioned and cautioned by my specialist about potential asthma symptoms in relation to NSAIDs (non steroidal anti-inflammatory drugs). I have also had a not so positive experience to one in particular.

What is aspirin sensitivity and its relationship to asthma?

In general, aspirin and NSAID are typically well tolerated by most people.1 However, those with asthma may need to be particularly alert if there is any suspicion of suspected sensitivities. There is a whole type of asthma that is dedicated to aspirin sensitivity.
Sensitivities associated with aspirin may include gastrointestinal toxicity and allergic-type reactions. There are two main types of asthma sensitivity.2 Classically, respiratory reaction and urticaria/angiodemia reaction.3
Those with respiratory sensitivities to aspirin or NSAID is estimated at 0.07-3.4% of the general population.
Respiratory reactions include bronchospasm, wheezing and decreased lung function.4

How do you know if you have an aspirin or NSAID sensitivity?

The definitive diagnosis is thought to be through a provocation challenge test.5 The oral route of administration is the most common and the generally the one used in North America. “The data has indicated that in most patients with sensitivity that the thresholds that evoke positive respiratory response are 30-150mg of aspirin.6 Established protocols have recommended a placebo challenge to eliminate the positivity of spontaneous bronchospasm.”6

Why are some NSAIDS safe for aspirin and NASAID sensitive asthmatics?

“Inhibition of the COX-1 enzyme by aspirin and non selective NSAIDs is key in the development of reactions observed in patients with sensitive to these medications. Based on this mechanism, NSAIDs that selectively inhibit the enzyme COX-2 (cyclo-oxygenase 2) may be safe in aspirin/NSAID-sensitive patients/”7 There have several studies that have looked at the safety of COX-2 in patients with asthma sensitivity.8 These studies concluded that COX-2 selective NSAIDs can be used safely in the majority of patients with aspirin-induced asthma. An example of selective COX-2 are Bextra, Celebrex and Vioxx.

Patients with aspirin induced asthma should avoid aspirin and NSAIDS.  Patients interested in using aspirin or NSAID are encouraged to discuss these options with their care team and to discuss alternatives that may be available.9

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