Women are twice more likely to be affected by aspirin-induced asthma. Symptoms usually develop gradually over several years [1], but patients with rapid progression have also been described [2]. If patients are atopic, chronic rhinitis and asthma occur earlier in life, unlike aspirin intolerance and nasal polyps [3]. The sense of smell is diminished in these patients [4]. Chronic asthma may have any severity. Even mild, intermittent asthma patients may have acute episodes induced by aspirin consumption and up to one-quarter of patients that need to be admitted to the hospital due to a crisis have ingested non-steroidal anti-inflammatories during the last 3 hours [5]. Respiratory symptoms (wheezing, dyspnea, cough) and chest pain [6] that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [7] and conjunctival injection. Less frequently, patients also have abdominal pain, hypotension, and laryngospasm.

If nasal polyps are removed, they tend to recur. Sinus mucosa is also polypoidal and hypertrophied. The initial episode of rhinitis in these patients often occurs after a viral infection [8].

• Unconsciousness

  The person goes into shock, becomes unconscious, or stops breathing.6 What medications trigger aspirin-induced asthma? Although it is called “aspirin-induced asthma,” medications related to aspirin can also cause an attack. [asthma.net]

• Nocturnal Awakening

  Pulmonary function improved significantly, and both ss-agonist use and frequency of nocturnal awakening decreased. Pranlukast, a LTRA available only in Japan, produced results similar to those reported for montelukast. [ncbi.nlm.nih.gov]

• Dyspnea

  The bronchial response (BR) was evidenced by dyspnea and spirometry, whereas the nasal response (NR) was evidenced by nasal symptoms and acoustic rhinometry and/or rhinomanometry. [ncbi.nlm.nih.gov]

  It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea ( DYSPNEA, PAROXYSMAL ). [hon.ch]

  […] characteristic symptoms of asthma (e.g., wheezes, congestion, dyspnea ) are absent. [amboss.com]

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

  Chiu 18 18 Congenital MVP,ASA.No regurgitation. dyspnea, dizziness worse with TDF/FTC/RAL Dr blames Dr. John Chiu Dr. Chiu Confusing: You need to use less abbreviations and provide a clearer description. [healthtap.com]

• Bronchospasm and Wheezing

  Albuterol administered by a nebulizer or through an inhaler (with good inhaler technique) can help with bronchospasm ( cough, wheezing, chest tightness ). It is imperative to avoid all Aspirin products and nsaids like ibuprofen. [healthtap.com]

• Suggestibility

  A 42-year-old man with aspirin-induced asthma also developed Prinzmetal's variant angina shortly after aspirin ingestion suggesting a possible physiologic relationship between bronchospasm and coronary spasm in aspirin-sensitive patients. [ncbi.nlm.nih.gov]

• Hyperalgesia

  Other effects that occur with therapeutically relevant amounts of nimesulide include (a) inhibition of the formation of superoxide anions by neutrophils, 23 (b) inhibition of histamine action and release, 24 25 (c) TNFα hyperalgesia, 26 and (d) synthesis [thorax.bmj.com]

The diagnosis of aspirin induced asthma is made from the history and clinical examination. In uncertain cases, challenge tests may be useful [8] for confirmation of the diagnosis. But, as they can provoke severe asthmatic episodes, they should only be performed in the hospital and aspirin can be administered by various routes: oral, nasal, bronchial and intravenous, in increasing doses for four consecutive days. Following administration, if a fall in forced expiratory volume in one second of at least 20% is observed, the test is considered positive [9]. Patients should receive leukotriene-modifying agents before the test because they have been proven to diminish the severity of bronchial constriction, while nasal and ocular symptoms tend to still appear, so the clinician can interpret the results of the test as positive. If lysine- aspirin is administered by inhalation route, only bronchial symptoms will occur. Inhalation tests may remain negative even in patients with positive oral tests. Oral and bronchial tests have similar specificity, but the oral test is more sensitive.

Several tests have been used over the years: histamine, methacholine, allergens and lysine-aspirin [10]. The Aspirin Sensitive Patient Identification Test is a new method to prove aspirin intolerance that still needs further validation [11].

Additional diagnostic methods include computer tomography scans of paranasal sinuses, that show mucosal hypertrophy and polyps. If the sinuses appear normal, the likelihood of aspirin-induced asthma is low.

Most patients are atopic [12] and some have increased respiratory antigen immunoglobulin E levels [13]. The peripheral eosinophil count can be high [14] and eosinophils are frequently found in the nasal and bronchial mucosa. The skin prick tests may be also positive for aeroallergens [15].

• Antinuclear Autoantibodies

  Antinuclear autoantibodies of SS-B specificity were present in the serum. Challenge with aspirin provoked asthma and distinct blood circulation disturbance in the hands. [ncbi.nlm.nih.gov]

• C3 Decreased

  After the aspirin challenge, C3 decreased in both patients with AIA and those with ATA, but the C3a concentration increased in the AIA patient group (p 0.019). [ncbi.nlm.nih.gov]

Weekly mean values of symptom scores were generally lower and PNIF measurements higher during treatment with FP than with placebo. This difference was statistically significant for most recorded parameters for the whole 4-week FP treatment. [ncbi.nlm.nih.gov]

The preferred treatment for many patients is desensitization to aspirin, undertaken at a clinic or hospital specializing in such treatment. [24] Patients who are desensitized then take a maintenance dose of aspirin daily to maintain their desensitization [en.wikipedia.org]

[…] severe allergic rhinitis, for the treatment of exercise-induced bronchospasm and for aspirin-induced asthma. [medical-dictionary.thefreedictionary.com]

Long- term prognosis for near-fatal asthma: a 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for near-fatal attack of asthma. Am Rev Respir Dis. 1992;146(1):76-81. [degruyter.com]

Abstract The etiology of aspirin-sensitive asthma is unknown, but a plausible hypothesis is that the inhibitory effect of aspirin on the cyclooxygenase enzyme increases formation of bronchoconstrictor leukotrienes via "shunting" of unmetabolized arachidonic [ncbi.nlm.nih.gov]

The etiology of ASA induced asthma is complex and not fully understood, but most evidence points towards an abnormality of arachidonic acid (AA) metabolism. [eurekaselect.com]

Asthma is a phenotypically heterogeneous disorder with many etiologic factors and clinical characteristics. T-bet, a Th1-specific transcription factor of T-box family, has been found to control interferon-gamma (IFN-gamma) expression in T cells. [uniprot.org]

Acetaminophen and the risk of asthma: The epidemiologic and pathophysiologic evidence. Chest. 2005;127(2):604-12. Hedman J, Kaprio J, Poussa T, Nieminen MM. [healthengine.com.au]

Kevin Li, Andrew Lee and Waleed Abuzeid, Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management, Medical Sciences, 10.3390/medsci7030045, 7, 3, (45), (2019). [doi.org]

She was awarded PhD and DSc degrees in specialities of pulmonology and pathophysiology in 1992 and 2002. She is a member of the European Respiratory Society (ERS) and European Network on Aspirin-Induced Asthma (AIANE). [books.google.com]

These two nonspecific triggers may also share pathophysiologic mechanisms, including mast cell and leukotriene-related pathways, and may be related to vascular response–mediated airway narrowing. [accessmedicine.mhmedical.com]

Redegeld Affiliation: Division of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. [eurekaselect.com]

In conclusion, preoperative evaluation of these patients and collaboration between the allergists and anesthesiologists is essential to prevent preoperative, perioperative and postoperative complications. [ncbi.nlm.nih.gov]

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