There are many types of asthma such as exercise-induced, cough-variant, occupational, allergic, and nocturnal. Different things may cause asthma attacks depending on the type of asthma. So those with asthma have to be aware of the types of incidents that cause their asthma to act up or stimulate an asthma attack. It may something as simple as an over the counter drug that the doctor prescribes to help your health that lead into an asthma attack. Who knew aspirin, an anti-inflammatory, could lead to a response that causes inflammation?
In Pathogenesis and Aspirin-Intolerant Asthma, http://www.ncbi.nlm.nih.gov/pubmed/16137190, the article studies the effect on taking aspirin when intolerant to aspirin. There are about 2-23% of adults and sometimes children whose asthma is worsened when taking aspirin and NSAIDS. Bronchoconstriction is rather rapid occurring within three hours of oral administration of aspirin. The asthma attack from aspirin is believed to be from inhibition of cyclo-oxygenase which takes place with overproduction of cysteinyl leukotrienes (cys-LTs). Due to the overproduction of cysteinyl leukotrienes, leukotriene modifiers are used in order to control aspirin induced asthma in the long-term.
So while taking asthma may beneficial for some that need to reduce coagulation, it can be harmful for those that have asthma. It would be beneficial to investigate exactly how aspirin induced asthma’s manner of development compares to other types of asthma. From this article is it interesting to read that patients with aspirin induced asthma are able to take aspirin by taking measures such as therapy or using selective cyclo-oxygenase 2 inhibitors.
I would have never thought that aspirin would be responsible for exacerbating asthma. One theory proposed on how this happens is called the AEA (Aspirin-Exacerbated Aspirin) COX pathway. It is explained that by the inhibition of COX-1 ( the target site of Aspirin) leads to reduction of prostaglandin E2 (PGE2) (the desired effect), which plays a role in inhibiting the uncontrolled synthesis of cysteinyl leukotrienes; the reduction in PGE2 leads to higher levels of leukotriene which can ultimately lead to bronchoconstriction, mucus plugging and edema, and cellular recruitment and infiltration in the airways. By considering this theory, we can see how possibly a Cox-1 inhibitor can contribute to exacerbating the reactions of asthma.
ReplyDeleteI wasn’t too clear on what your last sentence was stating in regards to how a patient with AEA can still take aspirin. You mentioned other therapies and selective cox 2 inhibitors would be involved; is that in addition to still taking aspirin or utilizing those treatments in replacement of aspirin? From class discussion, it is evident that taking both a cox-1 and cox-2 inhibitor would not be beneficial and that the introduction of cox-2 would eliminate the anti-coagulant effects aspirin (cox -1 inhibitor) provides. Actually, it is even being considered that possibly Cox-2 inhibition could play a role in AEA, considering patients with AEA had lower levels of mRNA of Cox-2.
References:
http://www.aacijournal.com/content/4/2/75
I have a small case of asthma and I find it interesting that you brought this topic up. I usually don't take any type of medication, even ill, especially over the counter. However, in the rare cases that I do take aspirin, there has been times where I felt worse. It's good to know that there has been actual research on this.
ReplyDeleteI find it interesting that over-the-counter drugs are continually being implicated in a wide variety of areas. Since OTC medications are so easily attained in developed countries, I feel that the fact that the drugs are still very powerful pharmaceuticals is often over looked by a majority of the public. I know that I personally have taken ibuprofen or aspirin to relieve a minor ache or pain without putting much thought into any possible side effects. It reminds me of a comment by Dr. Cohen in class about if these drugs had been discovered more recently would they still be allowed over-the-counter.
ReplyDeleteYou state that Who knew aspirin, an anti-inflammatory, could lead to a response that causes inflammation?" This is not really true. Aspirin induces a vasoconstriction which induces the asthma. Vasoconstricition is not an inflammation.
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