How does asthma interact with aspirin (Nonsteroidal Anti-Inflammatory Drug)?

From the Guidelines

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided by people with aspirin-exacerbated respiratory disease (AERD), a specific type of asthma that affects about 7-20% of adult asthmatics, as stated in the most recent study 1.

Asthma and Aspirin Interaction

Asthma can interact with aspirin in a way that triggers severe asthma attacks, nasal congestion, and potentially life-threatening bronchospasm in individuals with AERD. This reaction typically occurs within minutes to hours after taking the medication, as the drugs inhibit the cyclooxygenase-1 (COX-1) enzyme, shifting arachidonic acid metabolism toward the lipoxygenase pathway, which increases production of leukotrienes that trigger inflammation and bronchospasm in sensitive individuals 1.

Key Considerations

• If you have asthma, especially if you also have nasal polyps or chronic sinusitis, consult your healthcare provider before taking any NSAID, as recommended by recent guidelines 1.
• Acetaminophen (Tylenol) is generally considered a safer alternative for pain relief in people with AERD, though higher doses may still cause reactions in some highly sensitive individuals 1.
• Aspirin desensitization alone (without subsequent daily aspirin therapy) is thought to be ineffective for patients with AERD, and the diagnosis of AERD must be confirmed by a convincing history of a respiratory reaction to aspirin or nonsteroidal anti-inflammatory drugs (as judged by the clinician) or the development of respiratory symptoms during an aspirin challenge 1.

Management and Treatment

• Management of patients with AERD involves avoidance of aspirin and NSAIDs and aggressive medical and/or surgical treatment of underlying asthma and rhinitis or sinusitis, as stated in recent studies 1.
• Aspirin desensitization treatment improves clinical outcomes for both upper and lower respiratory tract disease, and daily administration of at least 325 mg of aspirin once daily is required for patients to remain in a tolerant state 1.

From the FDA Drug Label

Patients with known aspirin sensitivity should continue avoidance of aspirin or non-steroidal anti-inflammatory agents while taking SINGULAIR Although SINGULAIR is effective in improving airway function in asthmatics with documented aspirin sensitivity, it has not been shown to truncate bronchoconstrictor response to aspirin and other non-steroidal anti-inflammatory drugs in aspirin-sensitive asthmatic patients

Asthma Interaction with Aspirin:

• Patients with known aspirin sensitivity should avoid aspirin or non-steroidal anti-inflammatory agents while taking montelukast.
• Montelukast is effective in improving airway function in asthmatics with documented aspirin sensitivity, but it does not prevent bronchoconstrictor response to aspirin or other non-steroidal anti-inflammatory drugs in aspirin-sensitive asthmatic patients 2.

From the Research

Asthma Interaction with Aspirin

• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause deterioration in respiratory function in approximately 10% of adults with asthma and a smaller proportion of children with asthma 3.
• Patients with aspirin-exacerbated respiratory disease (AERD) or nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (NERD) must avoid aspirin and all other oral NSAIDs 4.
• The use of topical NSAIDs, especially salicylates, can also affect asthma control in patients with NERD phenotype, and it is essential to eliminate not only oral but also topical NSAID exposure in these patients 4.

Mechanism of Asthma Interaction with Aspirin

• Aspirin and NSAIDs inhibit cyclooxygenase activity, leading to an increase in cysteinyl leukotriene production, which plays a critical role in the pathogenesis of aspirin-induced asthma (AIA) 5, 6.
• The overproduction of cysteinyl leukotrienes, combined with the removal of the 'brake' imposed by the bronchodilator prostaglandin E2, may cause an asthma attack in patients with AIA 6.

Management of Aspirin-Intolerant Asthma

• Leukotriene modifiers are the preferred medication for the long-term control of aspirin-intolerant asthma (AIA), as they can reduce the risk of severe asthmatic responses 5, 7, 6.
• Patients with AIA should avoid the use of aspirin/NSAIDs or use selective cyclo-oxygenase 2 inhibitors when required, and aspirin desensitization therapy or treatment with selective cyclo-oxygenase 2 inhibitors may be necessary in specific situations 6.
• Oral, inhaled, nasal, or intravenous aspirin challenge tests can be used to diagnose AIA, but should be performed in facilities where experienced physicians are present and emergency treatment is available 6.