Aspirin, an unrecognised asthma trigger

Asthma is a disease of the lungs that can be triggered by things like dust, pollen, smoke, mould etc. But do you also know that painkillers like ibuprofen, and aspirin could also stimulate this breathing disorder?, reports Sade Oguntola

Are you one of those, who take aspirin for pain relief? Do you take time out to check out the composition of the medications you take? This practice may save you from many problems that ordinarily other people may have. One of such diseases that it might help you with is asthma. Many people are sensitive to aspirin and do not realise it. For instance, some people are not aware that the use of drugs containing aspirin is actually why they experience asthmatic attacks very often.

Many things can trigger asthmatic attacks in individuals that have asthma, a disease of the lung that affects millions of people worldwide. While asthma’s well known triggers include cat dander, dust, mould, feathers, pollen, cigarette smoke, and cockroach dust, Dr. Soji Ige, a chest physician at the University College Hospital (UCH), Ibadan, said painkillers such as aspirin, ibuprofen, acetaminophen (a pain reliever found in many cold and flu medicines), blood pressure reducing medications and strong eye drop for glaucoma can also trigger asthmatic attack in some individuals.

Dr. Ige said medications are a more common cause of asthmatic attacks in older people and that is why traditionally, people with asthma are told to avoid medications such as aspirin because they can cause or trigger asthma. He said even in adults that are prone to having aspirin-induced asthma, they only need to take a small amount (15 to 30 mg) of aspirin to bring on acute wheezing, coughing, shortness of breath and/or chest tightness. Dr. Ige said almost all nonsterodial anti-inflammatory drugs could trigger asthmatic attacks in some individual, explaining that the worst of them is aspirin. He said aspirin induced asthmatic attacks occur more in individuals with nasal polyps, small growths on the inside of the nose. In those are sensitive to developing asthmatic attack after taking aspirin and other drugs that induce asthmatic attacks, he said immediately they take the drug, they start to notice all the symptoms of asthma such as wheezing, coughing, chest tightness, rapid, shallow breathing or difficulty breathing and shortness of breath. In some individuals that are not too lucky, the symptoms could be very severe too.

He said many people with hypertension and glaucoma have had to change their medications to other ones, especially if they are asthmatic in nature, adding that not too many individuals are sensitive to such drugs. He said medical doctors and people that are asthmatic should have it at the back of their minds, the possibility that some drugs like aspirin, indocide, feldrene and drugs used for the treatment of hypertension and glaucoma can trigger asthmatic attack. He said they should be mindful of such reactions in the identification and history taken of any patient they see.

According to him, “Parents should be careful with aspirin in children because they do not know those with allergic diseases like asthma. This is more like a side reaction to the drug. It can cause acute or severe asthma, especially if they carry nasal polyps.” However, aspirin-induced asthma cases are not too exceptional. Experts have found that at least one in five asthma patients are sensitive to aspirin. Meanwhile, they are unaware that they are at risk of such a potentially life-threatening reaction to aspirin. A study that analysed 21 reports on aspirin-induced asthma in both adults and children in British Medical Journal said the occurrence of aspirin-induced asthma is about 21 per cent in adults and 5 per cent in children. In the research by Dr. Christine Jenkins with the Woolcock Institute of Medical Research in Australia, it was found that about one-half of the adults had reactions to low doses of aspirin (80 milligrams or more), indicating they were highly sensitive.

Sensitivity to three additional commonly used pain relievers was also seen in asthmatic patients sensitive to aspirin — ibuprofen, naproxen, and diclofenac. Ninety-eight per cent were sensitive to 400-milligram doses or less of ibuprofen; 100 per cent were sensitive to 100 milligrams or less of naproxen; and 98 per cent were sensitive to 40 milligrams or less of diclofenac. Unfortunately, this problem is underdiagnosed and underreported because of the lack of routine testing in asthmatic patients. Patients too often do not report aspirin sensitivity.

While symptoms of an asthma episode can be mild to severe and may include: wheezing, coughing, chest tightness, rapid, shallow breathing or difficulty breathing and shortness of breath, Dr. Jenkins suggested, based on the study, that anyone who is positively identified as having aspirin- induced asthma should avoid all Non Steroidal Anti inflammatory Drugs(NSAIDS) and products that contain aspirin.

NSAID’s, nonsteroidal anti-inflammatory drugs, are a class of over-the-counter pain relievers that include aspirin and ibuprofen. The researchers also said that given the serious implication of what aspirin and similar medications could cause in this group of individuals, anyone with asthma younger than 40 years of age should be informed about the risks of aspirin-induced asthma even if they have never had an incident. They say that it can develop later in life. In addition, those who think that aspirin may be an asthma trigger for them should report it to their doctors, because it can be fatal.

Medical science does not know how and why people develop asthma, but both environmental and genetic factors seem to play a role in the development of the disease. According to research, asthma is more prevalent in industrialised countries than in underdeveloped ones, which made some people to theorise that asthma is caused by industrial pollutants. However, the following factors appear to be associated with the onset of asthma symptoms in children:

• Smaller airways at birth and in early life.

• Exposure to tobacco smoke

• Male sex.

• Low birth weight.

• A parent, especially the mother, with allergies or asthma

• Other family members with asthma and allergy.

• Viral respiratory infections.

Asthma may appear to develop at any age. When asthma symptoms appear in adulthood, it may be a recurrence of unrecognised childhood asthma or a recurrence of asthma that had gone into remission during the early adolescent years.

Asthma in patients over the age of 20 appears to be more common and more severe in women. With adult onset of asthma, it may be due to work-related factors such as exposure to high-dose of ammonia, chlorine gas, or hydrochloric acid. The onset of asthma can also be linked to obesity in both children and adults. Weight loss in obese patients with asthma has been shown to improve symptoms, lung function, and their general health status.