Overview
Asthma attacks due to the application of certain medications are called drug-induced asthma (DIA), including asthma attacks caused by the application of certain medications in patients with no history of asthma and asthma attacks or exacerbation of asthma in patients with asthma due to the application of certain medications, with the most common form of drug-induced asthma being aspirin-induced asthma (AIA). Asthma induced by non-steroidal antipyretic and analgesic drugs represented by aspirin. Regardless of a previous history of asthma, when an induced asthma attack occurs within minutes or hours of taking oral aspirin, it is called aspirin-induced asthma (AIA).
Etiology
There may be a history of rhinitis, nasal polyps, or hypertrophy of the nasal mucosa, and the patient may develop asthma after taking aspirin because of an episodic sensation, dysmenorrhea.
Symptoms
People with a history of asthma, taking antipyretic analgesics immediately after the cause of severe asthma; no history of asthma, taking antipyretic analgesics immediately after the cause of severe asthma; sinusitis, nasal polyps, rhinitis, taking antipyretic analgesics immediately after the cause of severe asthma.
Aspirin-induced asthma occurs in middle-aged women, rare in children, its typical symptoms are conjunctival congestion within 30 minutes to 2 hours of taking the drug, runny, facial and chest skin flushing, heat rash, nausea, vomiting, diarrhea, occasional urticaria, accompanied by tightness in the chest, shortness of breath, dyspnea, severe shock, coma, respiratory arrest, this kind of patients with poorer therapeutic response, once the attack, no matter how serious or mild, should be taken seriously, no matter what the symptoms are. Therefore, once an attack occurs, regardless of the severity of the symptoms, it should be given high priority. If nasal polyps, aspirin allergy and asthma exist in combination, it is called aspirin-asthma triad.
Examination
Patients with bronchoalveolar lavage AIA have increased levels of leukotrienes in nasal secretions, urine, and bronchoalveolar lavage fluid.
A provocation test may be performed if the clinical features are consistent with the disease but the history is inconclusive.
Diagnosis
Drug-induced asthma is characterized by the following features: ① A clear history of drug use. ②An asthma attack that occurs a few minutes to a few days after the administration of the drug. (iii) Asthma caused by allergic reaction has systemic allergic reaction in addition to respiratory symptoms. ④After stopping the drug, most of the asthma can be relieved by appropriate treatment. ⑤ Previous use of this drug has a similar attack, or the next time the use of this drug or the same class of drugs can occur again asthma attack.
According to the above characteristics, it is not difficult to make the diagnosis of drug-induced asthma, for the suspicion of this disease, but the history of inaccurate, can be carried out to stimulate the test, aspirin stimulation test may induce severe bronchospasm, there is a certain degree of danger, so it must be carried out by experienced medical personnel in the conditions of good tracheal intubation, mechanical ventilation and other resuscitation preparations, and the specific practice is within 3 days from 3 mg or 30 mg of oral aspirin. The specific practice is to start oral aspirin from 3mg or 30mg in 3 days, and measure the lung function 3 hours after taking the drug, if the FEV1 decreases by ≥20%, then it is positive, if negative, then continue to take 60mg, 100mg up to 600mg orally, in order to shorten the time of the test, can be carried out in the lysine-aspirin inhalation test: inhale 11.25~360mg/mL of lysine-aspirin in every 45 minutes within 350 minutes, 4 puffs each time, this method is better than the other method, but also can be used in the lung function. This method is easier, shorter and safer than oral administration.
Differential diagnosis
It should be differentiated from cardiogenic asthma and atopic asthma.
Complications
Shock, coma, apnea may occur in severe cases.
Treatment
The general treatment principle of drug-induced asthma: once suspected of drug-induced asthma, stop using the suspected asthma-causing drugs immediately, and at the same time, give oxygen, keep the airway open, sputum suction and other treatments, and discretionary antihistamines, β agonists, high-dose glucocorticosteroids (not used if the patient’s asthma is induced by steroid hormones), and early mechanical assisted ventilation should be carried out for severe asthma. The most effective way to prevent DIA is to avoid reapplication of these drugs.
For AIA, acute cases are managed according to the above principles, while chronic cases can be treated with oral or inhaled glucocorticoids. The combination of antihistamines and mast cell stabilizers cromoglicic acid and ketotifen can reduce symptoms and glucocorticoid dosage. Leukotriene receptor antagonists and 5-lipoxygenase inhibitors are also effective. Aspirin desensitization can be performed in patients who cannot avoid aspirin and other NSAIDs. The specific method is as follows: oral aspirin 20 mg, 2 hours later oral 40 mg, and then every 2 hours increased by 40 mg up to 160 mg, the administration of the process of close observation of symptoms, signs and pulmonary function changes, if no reaction can be taken every day to take the final dose. After desensitization, patients should still take a daily dose of aspirin to maintain the desensitization effect. This treatment will keep most patients free of asthma attacks and cross-sensitize them to other NSAIDs while taking 325 to 650 mg of oral aspirin daily. Aggressive surgical treatment of AIA in patients with comorbid sinusitis and nasal polyps can also help control AIA.