Sunday, December 23, 2012

Aspirin and Asthma

If you have asthma, you may at some point have been told by a doctor never to take aspirin. At the same time we read about all the benefits of aspirin, including prevention of heart attacks and strokes and most recently as an aid in treating some types of colon cancer. Is it true that you need to forego these health benefits because you have asthma?

The brief answer is: in most instances, no. In most persons with asthma (probably at least 95%), aspirin acts in the same way that it does for everyone else. It alleviates pain, relieves headache, and reduces fever without any unusual side effects. The doctor’s admonition to avoid aspirin came from the observation that in a small subgroup of persons with asthma, perhaps 3-5%, aspirin provokes an asthma attack, sometimes quite a severe attack, with associated nasal congestion and sometimes abdominal discomfort. Asthma sufferers need to avoid aspirin and all aspirin-containing products only if their unique body chemistry causes them to suffer an asthma (and sinus) attack after aspirin ingestion.

The long answer is more complicated (of course!). Here are three additional points worth noting.

1. Persons with asthma in whom aspirin causes an asthma attack will develop the same severe reaction if they were to take ibuprofen (Motrin), naproxen (Aleve), or any similar category of medicine (called non-steroidal anti-inflammatory drugs or NSAIDs). They do not have a true “allergy” to aspirin but rather a chemical sensitivity or intolerance to any of this family of medications that act to block the protein in our bodies called cyclooxygenase 1.

2. Children with asthma do not experience “aspirin-exacerbated respiratory disease” or AERD, as this unique reaction to aspirin is now called. It only emerges later in life. There is no blood or breath test that allows your doctor to determine whether you are aspirin intolerant or not. The diagnosis is usually made by direct experience – taking an aspirin or ibuprofen or naproxen tablet and experiencing an attack of your asthma 30-90 minutes later.

3. Help is available. The Allergy group at Brigham and Women’s Hospital has special interest and expertise in this area. For the diagnosis of aspirin intolerance, it is possible to undergo a carefully structured “aspirin challenge” in a supervised medical setting (taking initially very small doses of aspirin and observing for an asthmatic reaction). For treatment of aspirin intolerance – besides avoidance of aspirin and all chemically-related products – it is possible to undergo aspirin desensitization, causing tolerance to these medications to develop.

Perhaps most exciting of all, the BWH AERD program is conducting research into why some persons with asthma develop aspirin intolerance and exploring novel medical treatments that might help block it. More information is available at the BWH AERD website: