For the first time, aspirin asthma was diagnosed in the early twentieth century, shortly after it began to be actively used in medicine. acetylsalicylic acid. Now, from this disease, according to various sources, suffer from 9 to 40% of all asthmatics. Such a spread in statistics is related to the fact that aspirin asthma is not so easy to diagnose, and often patients are given a general diagnosis. How to still suspect the disease and how to treat it, tell MedAboutMe.
Shortness of breath and allergies
Aspirin asthma occurs, as a rule, at the age of 30-50 years, most of the patients are women. This disease is considered a special variant of asthma, which is hypersensitive to nonsteroidal anti-inflammatory drugs (NSAIDs).
According to the symptoms, it is very reminiscent of a strong allergic reaction, but still allergies is not. The fact is that difficulty breathing in this case develops due to a violation of metabolic processes, and not due to an inadequate response of the immune system. With aspirin asthma, arachidonic acid metabolism is disturbed in humans, malfunctions lead to an accumulation of inflammatory mediators, and the bronchi are swollen, making it difficult for the person to breathe normally. Doctors are inclined to believe that this pathology is genetically determined. Therefore, if there are cases of hypersensitivity to anti-inflammatory drugs in the family, the risk of seizures increases.
Causes of Aspirin Asthma
Attacks of aspirin bronchial asthma primarily provoke nonsteroidal anti-inflammatory drugs. Such medication quite common, many are sold without a prescription and are often used to lower the temperature and relieve pain in case of acute respiratory infections. Among these drugs:
In addition, the NSAIDs include:
It should be borne in mind that if the reaction has developed to any one drug from this group and aspirin asthma is confirmed, then it is better to refuse other nonsteroidal anti-inflammatory drugs.
Also, patients with such a diagnosis may experience pseudo-allergy to products containing salicylates. With care you need to eat the following:
- tomato sauce.
In addition, products containing the yellow dye tartazin are introduced into the diet with caution. Very often in people with aspirin-induced bronchial asthma, it can also provoke asthma attacks.
Triad of symptoms: respiratory failure, sinusitis, drug intolerance
Aspirin bronchial asthma is considered a serious illness that can lead to disability. Signs of bronchospasm are quite vividly expressed and in the classical version of the disease they constitute the so-called triad of symptoms (the Triad of Fernand-Widal):
- Polypous sinusitis.
- Intolerance to nonsteroidal anti-inflammatory drugs.
- Bouts of choking.
In rare cases, aspirin asthma is atypical, for example, there is no rhinosinusitis, and the attack begins immediately with shortness of breath. For patients with this type of disease, the prognosis is most favorable.
In the classic version, the patient first complains of prolonged rhinitis. Moreover, nasal congestion and runny nose may occur on the background of acute respiratory viral infections, but do not pass after recovery. Moreover, over time, in a quarter of patients, rhinosinusitis is aggravated by polyps in the sinuses. In this case, the person ceases to smell, he has headaches, the vasoconstrictor drugs cease to function, and the congestion becomes chronic.
Against this background, taking aspirin or other NSAIDs lead to an asthma attack. Initially, the drugs cause only tearing, itching, sneezing and local pain, but can later provoke a full attack. Its main symptom is severe breathing difficulty – expiratory dyspnea appears, in which a person is difficult to exhale. On the background of bronchospasm, the temperature may rise, headaches appear, dizziness, reddening and swelling of the face.
Diagnosis of aspirin bronchial asthma
Aspirin bronchial asthma is diagnosed by the characteristic symptoms, in particular, by intolerance to NSAIDs. Therefore, it is very important for the doctor to collect the medical history correctly, to pay attention to all the characteristic complaints. Further diagnosis is carried out to assess the functions of respiration. In particular, a person undergoes physical examinations, which measure:
- Forced expiratory volume in 1 second (FEV1).
- Vital capacity of the lungs (VC).
- Peak expiratory flow rate (PSV).
Additionally, a chest x-ray, bronchoscopy, CT scan of the lungs, EchoCG and others are prescribed. The results of such studies will help determine how far the disease has gone and, accordingly, correctly assign treatment.
An important diagnostic method for aspirin asthma is a provocative aspirin test. In this examination, the patient is administered orally (ingestion), nasal (nasal drops) or inhalation (inhalation of a diluted drug) is administered acetylsalicylic acid or indomethacin. Diagnosis is quite indicative and accurately confirms or disproves the diagnosis, but nevertheless resort to it in extreme cases. This is due to the fact that such an examination can cause a severe attack of suffocation, dangerous to the patient’s life. Therefore, samples are carried out only in specialized centers and only after physical examinations, for example, the patient’s FEV1 must be at least 70% of the norm.
Treatment of aspirin bronchial asthma
Doctors divide the treatment of aspirin bronchial asthma into two blocks:
- Prevention of seizures.
- The provision of emergency medical care in the development of asphyxiation.
Among the preventive measures it is very important to follow the correct diet, in which products with salicylates are excluded from the diet. Also, the patient should avoid taking any nonsteroidal anti-inflammatory drugs – always carefully study the instructions to the medication and inform your doctor about intolerance.
During periods of remission, inhaled glucocorticoids are prescribed for the prevention of bronchospasm. And only if they are not effective, systemic glucocorticoids are used. Also, inhaled long-acting b2-agonists and anti-leukotriene preparations are prescribed to the patient.
When an attack occurs, it is very important to seek medical attention as quickly as possible. Exacerbations of aspirin asthma are very difficult and can end in death from suffocation. Self-medication with such a diagnosis is forbidden and life-threatening.
When an attack is appointed:
- Salbutamol or Fenoterol.
- Glucocorticoids (inhalation or injection).
- Anticholinergic drugs.
- Oxygen therapy.
- Injections of adrenaline (epinephrine).