What is the treatment for aspirin-induced bronchospasm?

From the Guidelines

The treatment for aspirin-induced bronchospasm primarily involves immediate discontinuation of aspirin or other NSAIDs and administration of bronchodilators such as albuterol (salbutamol) via inhaler or nebulizer (2-4 puffs every 4-6 hours as needed) 1.

Key Considerations

• Supplemental oxygen should be provided if oxygen saturation is low.
• For severe reactions, epinephrine (0.3-0.5 mg of 1:1000 solution intramuscularly) may be necessary, followed by systemic corticosteroids like prednisone (40-60 mg orally) to reduce inflammation.
• Antihistamines such as diphenhydramine (25-50 mg orally or IV) can help manage associated symptoms.
• For long-term management in patients with aspirin-exacerbated respiratory disease (AERD), leukotriene modifiers like montelukast (10 mg daily) may be beneficial 1.

Aspirin Desensitization

• Aspirin desensitization under medical supervision can be considered for patients who require aspirin therapy.
• The desensitization protocol typically starts with milligram amounts and is performed over hours to days.
• Patients who have undergone desensitization should continue to take aspirin daily to maintain tolerance, with a minimum dose of 325 mg once daily 1.

Prevention

• Patients with known sensitivity should avoid all aspirin-containing products and other NSAIDs.
• Carrying emergency medication, including an epinephrine auto-injector, is crucial for patients with a history of severe reactions.

From the FDA Drug Label

Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The treatment for aspirin-induced bronchospasm is albuterol sulfate inhalation solution. The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol administered three to four times daily by nebulization 2.

From the Research

Aspirin-Induced Bronchospasm Treatment

• The treatment for aspirin-induced bronchospasm, particularly in patients with aspirin-exacerbated respiratory disease (AERD), involves several approaches, including aspirin desensitization and the use of medications that modify the leukotriene pathway 3, 4.
• Aspirin desensitization is a process where patients are gradually exposed to increasing doses of aspirin to reduce their sensitivity to the drug, which can help in managing AERD symptoms 3, 5.
• Leukotriene modifier drugs have been shown to protect the lower airways from severe reactions during oral aspirin challenges, suggesting their potential in preventing aspirin-induced bronchospasm 3, 4.
• The use of a combination of inhaled corticosteroids, long-acting beta-agonists, systemic corticosteroids, and leukotriene modifier drugs can stabilize underlying airways in preparation for a reasonably safe and accurate oral aspirin challenge 3.
• COX-2 inhibitors may be a safer alternative for patients with AERD who require nonsteroidal anti-inflammatory drugs (NSAIDs), as they have been found to cause fewer respiratory symptoms compared to selective NSAIDs 6.

Management and Pathogenesis

• Understanding the pathogenesis of NSAID-induced reactions in AERD is crucial for developing effective management strategies. The involvement of cysteinyl leukotrienes (cysLTs) and the role of mast cells in the acute reactions suggest potential targets for pharmacotherapies 7.
• The current management of AERD includes aspirin desensitization and high-dose aspirin therapy, highlighting the need for ongoing research into the underlying pathophysiology and innovative treatments 5.