Non-steroidal anti-inflammatory drugs have a complex effect on inflammation and pain. Their use is often accompanied by various side effects, one of which is reactive bronchoconstriction after the use of acetylsalicylic acid. This phenomenon is called ” aspirin asthma” because of the clinical picture characteristic of asthma.
Aspirin asthma is represented by the Fernand-Vidal triad , which includes:
- the development of polyposis rhinosinusitis ;
- the phenomenon of asthma attacks;
- intolerance to non-steroidal anti-inflammatory drugs (NSAIDs).
Causes of the disease
The main provoking factors for the development of aspirin-dependent asphyxiation are substances and drugs containing salicylates (aspirin and other NSAIDs). However, the mechanisms of the effect of aspirin on the respiratory system are not fully understood. The modern pathogenesis of aspirin bronchial asthma is based on two theories of its occurrence.
Some researchers believe that the onset of intolerance to salicylate is manifested due to a violation of metabolic processes with arachidonic acid, which is involved in the development of inflammatory reactions. Salicylates inhibit the mechanisms of creation of cyclooxygenase , thereby suppressing the metabolic reaction with arachidonic acid and triggering other mechanisms of inflammation. A large amount of leukotrienes appears , which cause edema and bronchospasm.
Another theory speaks of the occurrence of an imbalance of prostaglandins in the body due to the use of NSAIDs, specifically, an increase in the amount of prostaglandin F, which causes bronchospasm, leading to suffocation. Some medical communities associate excess accumulation of prostaglandins with a hereditary predisposition.
In addition, natural salicylates are found in some foods, and their constant use causes asthma symptoms. Women are more likely to develop aspirin asthma. It rarely develops in children and adult men.
The main signs
Clinically, the course of aspirin-dependent asthma is divided into 2 periods. Patients often do not associate the initial stage with taking medications, and when the disease begins to progress, showing symptoms of suffocation, they turn to a doctor.
Early manifestations do not relate to the respiratory system, but often affect the functional characteristics of the endocrine and immune systems. Every sixth sick person suffers from a thyroid gland pathology. In women, menstrual disorders, early menopause are observed.
Many patients note a decrease in the functions of the immune system, which manifests itself in complaints of frequent ARVI. The nervous system is often involved in the process. Neurological disorders are characterized by:
- a strong emotional reaction to stress;
- feeling of inner tension;
- constant anxiety;
- manifestations of melancholic depression.
Later, the first symptoms of involvement of the respiratory system appear. Rhinitis develops, the treatment of which does not lead to recovery.
The height of the disease begins with the onset of asthma attacks or conditions close to bronchospasm . The disease manifests itself during hormonal changes, which corresponds to age:
- 30-40 years old – female;
- 40-50 – for men;
- puberty in children.
Most patients talk about the connection of an attack of suffocation with some factors, which include:
- inhalation of strong odors;
- physical activity;
- change in the temperature of the inhaled air in the evening and in the morning.
The asthma attack of aspirin origin is symptomatically different from ordinary asthma. Within 60 minutes after using aspirin and substances containing salicylates, the patient develops characteristic breathing difficulties, which are accompanied by:
- the outflow of a large amount of mucus from the sinuses;
- redness of the face and neck.
In addition, some patients have other manifestations that accompany an attack of aspirin asthma:
- decrease in pressure;
- increased secretion of saliva;
- pain in the stomach.
Unlike regular asthma, aspirin asthma quickly loses its attachment to the seasonality of attacks. Patients feel constant chest congestion. Conventional bronchodilators do not help them improve their condition. Severe series of attacks occur more than four times a year and are caused by various factors: from taking NSAIDs to inhaling hypothermic air and emotional distress. Many women have a connection between exacerbations and the second stage of the menstrual cycle.
Diagnosis of the disease
In the diagnostic measures of aspirin suffocation syndrome, there are no differences from ordinary asthma. Patient research begins with anamnesis and physical examination. Very often, complaints of nasal congestion and choking may be absent.
Further, the diagnosis includes laboratory and instrumental studies. The most reliable way to detect aspirin asthma is an aspirin challenge test. It is very dangerous and must be performed by a medical specialist in a center with an anti-shock ward or an intensive care unit.
Additional methods are a blood test, which reveals eosinophilia , and tomography of the sinuses, polyps are found on it. To establish the degree of suffocation, functional breathing disorders are examined, their degree is established.
Aspirin Asthma Treatment
The basic principles of therapy for aspirin bronchial asthma (BA) were formed by pulmonologists in the guidelines at the global conference on asthmatics. According to these principles, it is necessary:
- Control asthma symptoms.
- Take measures to prevent exacerbations, including the development of status asthmaticus.
- Maintain a close to normal functional state of the respiratory system.
- To achieve normal physical activity of the patient.
- Eliminate negative drug provoking factors.
- Prevent irreversible airway obstruction.
- Prevent death from suffocation.
To achieve these goals, it is necessary to carry out special therapy. The exclusion of drugs of the NSAID group and products containing natural acetylsalicylic acid is paramount. Further, the administration of drugs ( Epithalamin , Epifamin ) and activities aimed at increasing melatonin in the body, which helps the asthmatic to sleep normally, are prescribed .
Antioxidants are prescribed – substances that reduce oxidative processes in the body. In addition, various methods improve microcirculation in the bronchopulmonary system. Anti-inflammatory therapy is prescribed to stabilize cell membranes and reduce leukotrienes . Immunomodulators are included in treatment to increase the body’s defenses.
Sometimes desensitization of acetylsalicylic acid is used. The patient, under the supervision of doctors, begins taking aspirin with small doses. This treatment leads to a decrease in sensitivity to salicylates.
In recent years, leukotriene receptor blockers have been effectively used , with the help of which patients with aspirin asthma can even take salicylates without consequences. The main drugs in this group are Montelukast , Zafirlukast .
The prognosis is favorable with rational therapy, but a complete cure for the disease is impossible. Asthma is a lifelong disease, therefore, complex therapy and the elimination of salicylates from the diet do not lead to recovery, but reduce the number of exacerbations and attacks, helping to achieve remission.
Preventive measures are aimed at reducing the number of attacks and improving the general condition of the patient. It is necessary:
- exclude aspirin and all NSAIDs;
- follow a diet, excluding canned food, most fruits, beer, substances and products containing tartrazine ;
- exclude smoking and alcohol consumption.
Irregular therapy, diet refusal and home treatment with folk remedies can lead to status asthma. In this state, asthma attacks develop for almost no reason, often and are not relieved by drugs, which can lead to death.
To avoid serious complications, the patient must understand that asthma must be treated for life.