Leukotrienes have been found to be highly active in patients with aspirinhypersensitivity asthma. These chemicals appear to be the most important mediators of the asthmatic response in patients with aspirin-induced asthma.
Treatment with an anti-leukotriene agent (zileuton, zafirlukast, montelukast) has been highly effective in controlling asthmatic attacks in these patients. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Nonsteroidal anti-inflammatory drugs (NSAIDs) that also inhibit the enzyme cyclooxygenase may also cause a severe asthma reaction. Many new NSAIDs are being introduced that are widely prescribed for pain, headache, joint disease, and menstrual cramps. Two NSAIDs, ibuprofen and naproxen, are available without prescription. Aspirin and ibuprofen are often included in "cold remedies" sold over the counter. Patients should carefully review the ingredients of any OTC medication and if unsure of its safety, consult their physician. Generally, you should avoid "cold pills" since they often combine aspirin and antihistamines, two agents that may produce adverse reactions in patients with bronchial asthma. Because of possible asthmatic reactions to NSAIDs, patients with asthma should avoid these medications. In patients with illnesses such as rheumatoid arthritis where these medications are often needed, anti-inflammatory medications that do not inhibit cyclooxygenase may be tried. If a NSAID that may produce asthma must be given, it is best to administer the first dose in the physician's office with emergency medication for asthma on hand. Another approach in patients who may need a NSAID and who have asthma is to try and "desensitize" them to the medication, a procedure that would likely require hospitalization for close observation. Alternatives to aspirin and NSAIDs include acetaminophen, sodium thiosalicylate, and choline magnesium trisalicylate. Acetaminophen, widely available without prescription, has reportedly produced asthma attacks in a small number of patients. This reaction is extremely rare and as a rule, this drug represents a safe alternative to aspirin and the NSAIDs. Sodium thiosalicylate and choline magnesium trisalicylate are anti-inflammatory drugs that do not inhibit cyclooxygenase and are safe alternatives to aspirin and NSAIDs. These medications are only available by prescription.