Aspirin-induced asthma (AIA) is a form of asthma caused by aspirin and some other medications. It occurs in individuals with sensitivities to aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and rarely, paracetamol. It is also called NSAID-induced asthma and aspirin-intolerant asthma and is in the spectrum of diseases called aspirin-exacerbated respiratory diseases.
Aspirin-induced asthma contributes to up to 20% of adult asthma cases. The condition is characterized by persistent rhinitis, asthma, aspirin intolerance, and nasal polyps. Diagnosis is based on these clinical findings with provocation testing done for confirmation. Treatment generally consists of avoiding NSAIDs. Desensitization may be employed in patients who must continue taking these medications.
According to a systematic review of the literature in 2004, the prevalence of AIA among adult asthmatics is 21%, and 5% in children with asthma.[1] Females are more commonly affected than males.[2]
The mechanisms by which NSAIDs induce asthma in susceptible individuals are currently unknown. Several hypotheses exist; the two most popular are the COX-1 theory and [3]
Medication | Incidence |
---|---|
Naproxen | 100% |
Ibuprofen | 98% |
Diclofenac | 93% |
Paracetamol | 7% |
Individuals with AIA are frequently sensitive to not only aspirin, but to other nonsteroidal anti-inflammatory drugs (NSAIDs) as well, including ibuprofen, naproxen, and diclofenac.[1] There is considerably less cross sensitivity to paracetamol.[1]
The clinical course of patients with AIA appears to follow a predictable course, progressing from persistent rhinitis, followed by asthma, aspirin intolerance, and the development of nasal polyps.[2] The first episode of aspirin-induced asthma most commonly develops following an upper respiratory infection.[2]
Provocation testing.[4]
AIA is difficult to treat.[5]