Aspirin asthma (AA) is a disease in which the main causative factor is the intake of a medication with analgesic, antipyretic and anti-inflammatory effects, related to non-steroidal anti-inflammatory drugs (NSAIDs). This is a special type that occurs on average in 10-40% of patients with bronchial asthma.
What it is? This is a pathological condition when the human respiratory system reacts too sharply to penetration into the body by any means (through the mouth, intravenously, etc.) of a substance like aspirin. Selective damage to the bronchi and lungs, manifested by difficulty in breathing, is masked by signs of bronchial asthma and is difficult to treat with standard treatment.
What is Aspirin Asthma
Aspirin bronchial asthma (BA) is one of the clinical variants of bronchial asthma with a special pathogenetic mechanism associated with intolerance to analgesics and antipyretic (non-steroidal anti-inflammatory) drugs.
The most common cause of the development of aspirin asthma is the representatives of the salicylate group (aspirin) and indoleacetic acid derivatives (indomethacin).
However, it must be remembered that aspirin asthma can be provoked by combined medications containing the active ingredient acetylsalicylic acid, as well as food products containing salicylates (citrus fruits, berries, tomatoes) or food additives / dyes that give a yellowish tint to products (tartrazine).
Attention is drawn to the clinical feature of this form of bronchial asthma, characterized by a complicated course with frequent exacerbations. At the same time, it can be difficult to achieve complete restoration of airway patency.
The mechanism of development and causes of the disease
To date, there is no single generally accepted pathogenetic theory to explain aspirin asthma. Through research, it has been found that after taking aspirin-containing and other non-steroidal anti-inflammatory drugs, the normal mechanism of conversion of arachidonic acid, which is necessary for the formation of substances regulating the functions of important organs, changes to a pathological one.
As a result of the altered cycle of arachidonic acid, an excess (overproduction) of leukotrienes is observed . These substances intensify the inflammatory reaction, under their influence, edema develops and bronchial contractility increases, mucus secretion increases, myocardial blood supply and heart rate decrease.
In bronchial asthma, the severity of the disease depends not only on the intensity of the inflammatory process in the bronchi, but also on where these processes are located. A feature of the pathogenesis of aspirin asthma is the involvement of not only large and medium bronchi, but also small airways (whose diameter is less than 2 mm), as well as lung tissue.
Extensive inflammatory damage to the mucous membrane of the respiratory system leads to irreversible disturbances in the function of gas exchange (inhalation of oxygen and exhalation of carbon dioxide). As a result, such complicated forms as physical exertion asthma, nocturnal asthma, severe bronchial asthma with a high risk of repeated exacerbations, and severely controlled asthma are formed.
Aspirin asthma symptoms
Several clinical variants of aspirin asthma have been described and studied :
- “Pure” form;
- asthmatic triad;
- combination of NSAID intolerance with allergic asthma.
In the first variant, there is a clear pattern of asthma symptoms in the form of acute shortness of breath and cough after taking salicylate derivatives.
The second form, according to its name, can be represented by the formula: anaphylactoid reactions to NSAIDs + asthmatic dyspnea + pathology of the nasal mucosa in the form of polyps.
Distinctive features of the triad are nasal congestion, decreased or no sense of smell, pain in the projection of the paranasal sinuses, headache. When these symptoms begin to be combined with features of spasms of the bronchi, which leads to respiratory failure, you should evaluate the association with aspirin or other NSAIDs. With the progression of the disease, the likelihood of anaphylactoid manifestations in the form of rashes, inflammation of the nasal mucosa, conjunctivitis, and disorders of the digestive system increases .
For the third, more complex form, there is a risk of developing severe respiratory pathology , since aspirin asthma is resistant to treatment with glucocorticoid hormones, and the latter are the main group of drugs for helping with life-threatening asthma attacks.
In general, considering the symptoms of aspirin intolerance, a wide range of clinical manifestations can be distinguished:
- redness of the skin of the face or upper body;
- shortness of breath and coughing;
- inflammation of the nasal mucosa and eye mucosa (conjunctivitis);
- hives-type rash;
- angioneurotic edema (Quincke type);
- increased body temperature;
- pain in the upper abdomen, sometimes accompanied by nausea or vomiting.
- status asthmaticus as a severe exacerbation of asthma;
- stopping breathing
- loss of consciousness
In this case, the first signs of an onset disease may include only sneezing, a runny nose or nasal congestion and facial flushing. And these symptoms appear 1-3 hours after taking aspirin or other NSAIDs.
To confirm the diagnosis of ” aspirin bronchial asthma”, the characteristic diagnostic parameters should be taken into account:
- An attack of lack of air caused by the intake of a provoking substance (derivatives of salicylates or the food additive tartrazine) occurs in the range of 1-2 hours.
- Possible development of the asthmatic triad: aspirin asthma + intolerance to salicylates + rhinosinusitis or pathology of the nasal mucosa as a polyposis.
- Decrease in external respiration indicators (for example: vital capacity of the lungs, peak (maximum) expiratory flow rate, etc.).
- Positive test with aspirin or other modifications of provocative tests (for example, with indomethacin or tartrazine).
It should be remembered that diagnostic tests should be carried out in the presence of an intensive care unit and experienced doctors.
First aid for an attack
Acute breathing disorder (attack) develops with an exacerbation of aspirin asthma and can occur unpredictably upon contact with a causative factor or a violation of the patient’s emotional state.
In the event of respiratory failure, the patient should be offered to take a comfortable semi-sitting position and to ensure the flow of cool fresh air into the room. It is necessary to measure blood pressure and monitor changes in pulse and respiratory rate.
A mild form of an attack can be eliminated by inhalation of a drug from the group of selective β2-adrenoreceptor stimulants every 20 minutes for 1 hour.
A moderate form of an attack should be eliminated with injectable bronchospasmolytics .
The most severe form of an attack is called status asthmaticus, which can be recognized by the following criteria:
- acute attack of shortness of breath (respiratory rate – up to 40 in 1 min):
- the predominance of difficult exhalation over inhalation at rest;
- bluish skin tone;
- excessive sweating;
- heart rate increases;
- rise in blood pressure to high levels;
- involvement of auxiliary muscles in breathing (intercostal muscles, muscles of the shoulder girdle, etc.);
- excruciating cough;
- the patient has to take a sitting position to facilitate breathing.
Emergency care for status asthmaticus includes:
- Inhalation of humidified oxygen.
- The use of systemic hormones.
- Intravenous infusion of bronchodilators .
- Infusion therapy aimed at eliminating circulatory pathology and preventing [M28] blood thickening.
- If necessary, artificial lung ventilation.
- Symptomatic therapy.
The provision of emergency care should be accompanied by constant monitoring of laboratory parameters and carried out under the guidance of a physician.
It is recommended to determine the tactics of treating aspirin asthma under the guidance of an allergist. The choice of direction, duration and method of treatment depends on the severity of the disease, the age of the patient and the presence of concomitant pathologies.
Therapy necessarily includes the following components:
- Compliance with a diet.
- Elimination of the risk of ingestion of medicines containing salicylates or components of non-steroidal anti-inflammatory drugs.
- Basic pharmacotherapy of bronchial asthma, aimed at breaking the chain of formation of inflammatory substances.
- Formation of tolerance (insensitivity, immunity) to the repeated action of salicylate derivatives.
As for the diet, it must be remembered that salicylates are natural, contained in foods (for example, some berries, fruits, vegetables, drinks with herbs or products made from root vegetables), as well as synthetic ones used for canning. In addition, you need to know about the adverse effect of using the food coloring tartrazine. Since it was recorded that in 30% of patients with aspirin intolerance, a cross-reaction to tartrazine is observed (designation on the packages – E-102), it is recommended to monitor the presence of such an additive in products or visually determine its presence in confectionery, ice cream, soda water, which clearly have yellow color or tint.
The second important condition for successful treatment is the exclusion of the possibility of penetration into the body of medications, which include aspirin derivatives or synthesized chemicals classified as NSAIDs. You should carefully study the composition of the active ingredients of the drug and possible side reactions associated with its intake.
In addition, it should be remembered that the food additive tartrazine can also be found in some medicines or medical products such as multivitamin complexes, toothpastes, and others.
Basic therapy of bronchial asthma must comply with modern clinical treatment protocols and be carried out by specialists. According to international recommendations, such treatment should include the following components:
- membrane stabilizing drugs;
- blockers (antagonists) of leukotriene receptors. Some of them block leukotriene receptors (the active ingredient is montelukast ), others inhibit the enzyme lipoxygenase and reduce the synthesis of leukotrienes .
- treatment with glucocorticoids, mainly for severe disease.
The effectiveness of the desensitization method has been clinically proven to form the body’s immunity (tolerance) to salicylates . It is based on the property of the patient’s immune system not to respond to repeated administration of a provoking substance, since there is a depletion of airway receptors. To form such an effect, the scheme provides for the introduction of aspirin in the initial minimum dose (for example, 5-10 mg), followed by monitoring of the respiratory function. If there is no negative reaction of the body, the dose is increased by 5-10 mg, and the monitoring cycle is repeated further. Upon reaching the threshold of sensitivity for the provoking factor, a maintenance dose of aspirin is selected.
A prerequisite for desensitization is an inpatient treatment by an experienced physician with the availability of funds for emergency assistance.
Diet for aspirin asthma
Patients with aspirin asthma are advised to refrain from eating smoked meats, as they may contain derivatives of salicylic acid. Another source of salicylates is vegetables, roots, citrus fruits. Natural salicylates are found in black currants, raspberries, apricots, and cherries. The use of these products, even in small quantities, can provoke bronchospasm.
Some foods contain a chemical compound that is analogous to aspirin in terms of action on the human body. This is tartrazine (E-102) – a synthetic additive / yellow dye used in the confectionery and canning industry.
Patients need to carefully study the composition of such products or completely abandon them in order to prevent an exacerbation of the disease, especially since the components indicated on the package do not always correspond to those that the manufacturer actually included in the product.
The set of measures, during the implementation of which, will ensure the prevention of the appearance of signs of aspirin bronchial asthma and eliminate risk factors for its exacerbation, includes:
- adherence to diet and requirements for the quality and composition of food;
- elimination of the likelihood of taking medications with analgesic, antipyretic and anti-inflammatory effects related to non-steroidal anti-inflammatory drugs (NSAIDs);
- the use of drugs of the group of blockers of leukotriene receptors, which can prevent day and night symptoms of bronchial asthma, reduce the manifestations of concomitant seasonal and year-round allergic rhinitis.
In any case, a timely visit to a doctor will minimize the likelihood of complications and help in effective treatment.