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Aspirin and Asthma

      Aspirin is not only one of the best-documented medicines in theworld, but also one of the most frequently used drugs of all times. Inaddition to its role as an analgesic, aspirin is being increasinglyused in the prophylaxis of ischemic heart disease and strokes. Theprevalence of aspirin intolerance is around 5 to 6%. Up to 20% of theasthmatic population is sensitive to aspirin and other nonsteroidalanti-inflammatory drugs (NSAIDs) and present with a triad of rhinitis,sinusitis, and asthma when exposed to the offending drugs. Thissyndrome is referred to as aspirin-induced asthma (AIA).The pathogenesis of AIA has implicated both the lipoxygenase (LO) andthe cyclooxygenase (COX) pathways. By inhibiting the COX pathway,aspirin diverts arachidonic acid metabolites to the LO pathway. Thisalso leads to a decrease in the levels of prostaglandin (PG)E2, the anti-inflammatory PG, along with an increase in thesynthesis of cysteinyl leukotrienes (LTs). Evidence suggeststhat patients with AIA have increased activity of LTC4synthase, the rate-limiting enzyme in the cysteinyl LT synthesis, intheir bronchial biopsy specimens, thereby tilting the balance in favorof inflammation. LT-modifying drugs are effective in blocking thebronchoconstriction provoked by aspirin and are used in the treatmentof this condition. Aspirin desensitization has a role in the managementof AIA, especially in patients who need prophylaxis from thromboembolicdiseases, myocardial infarction, and stroke. This review covers thelatest understanding of pathogenesis, clinical features, and managementof AIA.

      Key words

      Abbreviations:

      AIA (aspirin-induced asthma), ASA (acetylsalicylic acid), ATA (aspirin-tolerant asthma), COX (cyclooxygenase), CSS (Churg-Strauss syndrome), IL (interleukin), LO (lipoxygenase), LT (leukotriene), NSAID (nonsteroidalanti-inflammatory drug), PG (prostaglandin)
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