Can nonsteroidal anti-inflammatory drugs be used in adult patients with asthma?

· London and South East Regional Medicines Information Service

NSAIDs are contra-indicated in patients in whom attacks of asthma have been precipitated by aspirin or any other NSAID. Further studies are required to confirm the safety and tolerability of both COX-2 specific inhibitors and COX-2 selective inhibitors as ÒsafeÓ alternatives to non-selective NSAIDs in patients with AIA. At present, their use in patients with AIA would be outside the product licence.

For adult asthmatic patients who have not been exposed to aspirin or other NSAIDs, it is not possible to provide a definitive answer. However, in making the clinical decision as to whether aspirin/NSAIDs should be used in this patient group, the following should be considered:

¥ Prevalence of aspirin induced asthma (AIA) in adult asthmatics is approximately 10%, and patients who are sensitive to aspirin will often exhibit cross-sensitivity to other NSAIDs.

¥ Clinical features that suggest an increased risk of sensitivity to aspirin/NSAIDs in asthmatics include female sex, middle age, severe asthma accompanied by chronic nasal congestion and profuse rhinorrhoea, and a history of nasal polyps. Aspirin/NSAIDs can induce asthma/bronchoconstriction and a range of other symptoms in susceptible patients. These can range from mild reactions which may not be recognised clinically to severe and life threatening asthma.

¥ Based on prevalence data, approximately 80-90% of adult asthmatics will be able to tolerate aspirin and other NSAIDs, but may need to be warned of the potential for development of AIA, particularly late in life.