Staying informed about medical conditions that may impact our patients’ oral health is crucial. Asthma, a chronic respiratory condition affecting millions worldwide, requires special attention, especially concerning its relationship with nonsteroidal anti-inflammatory drugs (NSAIDs). Between 8% and 20% of adults diagnosed with asthma, and up to 30% of those with asthma and nasal polyps, may experience a condition known as Aspirin-Exacerbated Respiratory Disease (AERD) [1, 2].
AERD is primarily triggered by acetylsalicylic acid (“Aspirin”), with up to 9% of individuals reacting to non-Aspirin NSAIDs like ibuprofen or diclofenac [3, 4]. It typically manifests in adulthood, between the ages of 20 and 50, with symptoms appearing within 30 minutes to three hours after NSAID intake [1, 2, 4, 5, 6]. These symptoms include nasal congestion, rhinitis, sneezing, bronchospasm, and a productive cough. If left untreated, symptoms can escalate inseverity, posing life-threatening risks [1, 2, 5].
The mechanism of AERD involves increased activity of leukotriene synthase, leading to leukotriene-mediated upper airway inflammation. While Aspirin desensitization and leukotriene modifiers like montelukast (“Singulair”) are treatment options, identifying Aspirin sensitivity can be challenging [2, 6].
Acetaminophen (“Tylenol”) remains the recommended analgesic for patients with AERD due to its low incidence of sensitivity [2]. However, emerging evidence suggests that selective COX-2 inhibitors, such as celecoxib (“Celebrex”), are safe alternatives for anti-inflammatory purposes [9]. Meloxicam (“Mobicox”) should be used cautiously at low doses, as its COX-2 selectivity diminishes at higher doses.
In conclusion, while most individuals with asthma can tolerate NSAIDs, those with AERD are at risk of severe reactions. Dentists should screen for asthma and NSAID sensitivity, inquire about previous NSAID ingestion and AERD symptoms, and consider alternative analgesics for high-risk patients. COX-2 inhibitors are preferred for anti-inflammatory purposes in individuals with AERD.
NB: Severe asthma with long-term nasal congestion and polyps are at highest risk of Aspirin or NSAID sensitivity followed by sudden, severe asthma (admitted to hospital) and adult-onset asthma and with no known allergic cause.
Source: Ryan Pelletier, PharmD, RPh & Adriano B. Brescacin, DDS
References:
1. Morris MJ, Mosenifar Z et al. What is the triad of asthma, aspirin sensitivity, and nasal polyps? Medscape.
2. Aspirin-exacerbated respiratory disease. American Academy of Allergy Asthma & Immunology.
3. National Asthma Council. Aspirin/NSAID-intolerant asthma: pharmacy notes.
4. Morales DR, Guthrie B, Lipworth BJ, et al. NSAID-exacerbated respiratory disease: a meta-analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity. Allergy.
5. Thien F, Lewis A, Abramson MJ. Prevalence of NSAID intolerant asthma in a community-based sample. Intern Med J.
6. Sturtevant J. NSAID-induced bronchospasm: a common and serious problem. MedsafePrescriber Update.
7. Johnson K. Alcohol Triggers Symptoms in Some Aspirin-Associated Asthma.
8. Debley JS, Carter ER, Gibson RL, et al. The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled bronchoprovocation challenge study. J Pediatr.
9. Kowalski ML, Makowska JS. Seven steps to the diagnosis of NSAIDs hypersensitivity: How to apply a new classification in real practice. Allergy Asthma Immunol Res.
Disclaimer: The statements made in the above article are published on authority of the author and have not been peer reviewed. They do not necessarily reflect the views of Dental Digest and publishing them is not to be regarded as an endorsement of them by Dental Digest.