Aspirin-Induced Asthma

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KEY POINTS

• Asthma is a lung disease that causes coughing, wheezing, and shortness of breath. Aspirin-induced asthma is triggered by taking aspirin, ibuprofen, naproxen, or other NSAIDs.
• Treatment may include asthma medicines that you inhale or take by mouth. Some children may be treated with a kind of therapy called aspirin desensitization. This process must be supervised by an experienced healthcare provider.
• To help prevent aspirin-induced asthma, help your child avoid products that contain aspirin. Be sure to read labels. Several medicines contain aspirin or other NSAIDs.

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What is aspirin-induced asthma?

Asthma is a long-lasting (chronic) lung disease. It causes coughing, wheezing, and shortness of breath.

Aspirin-induced asthma is asthma triggered by taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, and naproxen are NSAIDs.

This kind of asthma is not common in children.

What is the cause?

Asthma symptoms are caused by two different problems in the airways.

• One problem is that the muscles in the airways tighten up, which causes chest tightness and wheezing.
• The other problem is swelling, irritation, and too much mucus in the airways.

If your child has asthma, symptoms often start after your child is exposed to a trigger. Asthma triggers can include:

• Exercise
• Allergies, such as dust, pollen, mold, or animal fur
• Something that irritates your child’s lungs, such as cold air, smoke, or strong smells like paint or perfume
• Medicines like aspirin or NSAIDs
• An infection such as a cold, the flu, or a sinus infection
• Strong emotions or stress
• Indigestion, also called gastroesophageal reflux disease, or GERD. If your child often has problems with acid indigestion, he may have more asthma symptoms, especially at night.

What are the symptoms?

The first symptoms of aspirin-induced asthma may include sneezing, a runny or stuffy nose, and redness and warmth of the face. Symptoms start 1 to 3 hours after taking aspirin or NSAIDs. The asthma attack triggered by aspirin and NSAIDs can be life threatening. In many cases, people with aspirin-induced asthma also have nasal polyps (growths in the lining of the nose or sinuses), long-term sinus disease, and loss of the sense of smell.

Children with asthma may not be sensitive to aspirin at first. They may have taken aspirin or NSAIDS in the past without any side effects. Symptoms may not start until adulthood.

How is it diagnosed?

There are no blood tests or skin tests that will diagnose allergy to aspirin or NSAIDs. Your child's healthcare provider will ask:

• Your child’s use of aspirin
• How often your child is having symptoms
• Any other allergies or triggers

The provider may refer your child to an allergy specialist to see if your child has other allergies.

How is it treated?

If your child has been diagnosed with aspirin-induced asthma, do not give your child products that contain aspirin.

In general, aspirin-induced asthma is managed in the same way as other types of asthma. Three types of medicines are used to control asthma:

• Quick-relief medicines, also called reliever, or rescue medicines. These medicines are used as needed to treat asthma attacks. They are not used on a regular, daily basis to prevent asthma symptoms. You and your child should learn to recognize the symptoms of an asthma attack and take these medicines as soon as symptoms start. To prevent asthma attacks, your child may need a different type of medicine called a controller.
• Long-term control medicines, also called controller medicines. By taking this medicine regularly every day, it helps to control your child’s symptoms. Your child will take these medicines every day, even if your child is not having symptoms. They do not provide quick relief of wheezing in acute asthma attacks.
• Steroid medicines, also called asthma controller medicines, because by taking them regularly every day, they help to control your child’s symptoms. Your child will take these medicines every day, even if your child is not having symptoms. They do not provide quick relief of wheezing in acute asthma attacks. Steroid medicines are similar to hormones made by the body. They block some of the chemicals that cause irritation and swelling in the airways. By lessening the swelling, you will have fewer symptoms and be able to breathe better.

Some children may be treated with a kind of therapy called aspirin desensitization. Your child starts by taking a very small dose of aspirin in a medical setting where there is emergency support. This process must be supervised by an experienced healthcare provider. Do not let your child try this alone. The dose is carefully and gradually increased until a normal dose of aspirin can be taken without causing symptoms. As the dose is increased, there is a chance of a sudden asthma attack. Once your child is able to take a normal dose of aspirin without having symptoms, your child will keep taking that dose every day. As this happens, your child’s symptoms will decrease. This can reduce the need for asthma medicines and improve asthma control.

It’s a good idea for your child to wear some form of ID (such as a Medic Alert bracelet) that says that he or she has aspirin-induced asthma. If your child needs emergency care, surgery, or lab tests, this helps the healthcare provider know how to treat your child.

Can it be prevented?

Aspirin-induced asthma can be prevented. Avoid products that contain aspirin. Be sure to read labels. Several medicines contain aspirin or other NSAIDs.

Do not give aspirin to children 18 years or younger unless told to do so by your healthcare provider. This is due to the risk of Reye's syndrome (an illness that causes inflammation of the brain and liver).

If your child has asthma, use NSAIDs such as ibuprofen with caution. If your child has asthma and nasal polyps, do not use NSAIDs without the approval of your child’s healthcare provider.

In rare cases, acetaminophen may also trigger an asthma attack. Reactions are usually less intense than reactions to aspirin or other NSAIDS. Acetaminophen is the medicine most often used for fever and pain relief for people who cannot take aspirin and NSAIDs.