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AIA facts
n Some people may not know
3,6
that they have AIA. Higher rates
have been reported in challenge
Aspirin/NSAID-intolerant studies, in which people with
asthma were given test doses of
these medications in a medically
asthma: pharmacy notes 6
supervised setting.
n A person with AIA typically
begins to experience symptoms
Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) can
at around age 30: first as severe
provoke asthma symptoms in some people with asthma.
rhinitis (runny and/or blocked
nose and sneezing), followed by
Aspirin/NSAID-intolerant asthma (AIA)* Practice points for
a loss of sense of smell, nasal
is a distinct type of asthma that affects community pharmacy
1,2
polyps and chronic sinusitis.
about 3-11% of adults with asthma.
Asthma typically develops over
Symptoms typically occur within 1-3
3,7, 8
All products that contain aspirin or
the next few years.
3-5
hours of taking aspirin or NSAID orally,
5,6
any NSAID should be avoided by: n AIA is not an allergy to these
and include some or all of these symptoms:
n anyone who has been 5
medications, but reactions can
shortness of breath, severely watery nose
diagnosed with AIA
be clinically significant and even
or rhinitis, red eyes, puffiness around the
n anyone who has previously 3
life-threatening if severe airway
3,4
People who
eyes and skin redness.
experienced runny nose or
narrowing occurs.
have experienced sensitivity to aspirin
wheezing 1-3 hours after taking
or one NSAID are likely to react to
aspirin or NSAIDs.
6
other NSAIDs.
AIA is unlikely in a person with risk
Who is at risk?
factors who has used these medications
These people should be advised to
5,6
regularly (e.g. daily low-dose aspirin) or
Most people with asthma can tolerate
unless
use paracetamol instead,
6
recently (e.g. within past 6 months)
aspirin and NSAIDs.
contraindicated. Some people with
5
without experiencing symptoms.
AIA also have mild reactions to higher
The risk of a reaction to aspirin or NSAIDs
3,5,6
§
3
doses of paracetamol (1000-1500 mg).
Selective COX-2 inhibitors are associated
is highest in:
Leukotriene receptor antagonists (e.g.
n people with severe asthma who with lower risk than other NSAIDs in people
3,4,10
montelukast) are used for long-term
Celecoxib appears to be well
with AIA.
experience long-term nasal congestion
control of AIA, but people taking leukotriene
tolerated. NSAIDs that are COX-2 selective
and severely watery nose
n people with recurring nasal polyps receptor antagonists must still avoid
only at low dose (e.g. meloxicam) may
4
n people who experience sudden, severe aspirin and NSAIDs.
cause airway constriction (bronchospasm)
10
asthma (e.g. have been admitted to
at higher doses.
People with risk factors for AIA (severe
intensive care with asthma)
asthma, long-term nasal congestion and
n people who first experience asthma as Any analgesic class can be considered
severely watery nose, nasal polyps, sudden
for other adults with asthma who have
adults and do not have known allergies
severe asthma, adult-onset asthma) should
not experienced reactions with aspirin
as the cause.
be advised to take precautions when using
†
with appropriate advice on
or NSAIDs,
5
these medications:
6
AIA is much less common in children
potential risk.
4,9 n Always carry reliever medication.
The prevalence of
than in adults.
n Know what to do if symptoms occur *Also called “aspirin-exacerbated respiratory
ibuprofen-sensitive asthma was 2%
disease” or “aspirin-sensitive asthma”.
– have an up-to-date written asthma
in a challenge study in children with
†Unless contraindications or precautions apply.
9
mild-to-moderate asthma.
action plan and follow it.
§ Under Australian Approved Product Information,
all COX-2 selective inhibitors (like other NSAIDs)
Everyone with asthma should have an up-to-date
are contraindicated in patients who have
experienced asthma, urticaria or allergic type
written asthma action plan prepared by their doctor.
reactions after taking aspirin or other NSAIDs.
References
Proudly supported
by Reckitt Benckiser
1. Thien F, Lewis A, Abramson MJ. Prevalence of NSAID intolerant asthma in a community based sample. Intern Med J 2008; 38 (Suppl 6): A166.
This resource was supported
2. Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002; 57: 569–74.
by an unrestricted educational
3. Morwood K, Gillis D, Smith W, Kette F. Aspirin-sensitive asthma. Intern Med J 2005; 35: 240–6.
grant from Reckitt Benckiser.
4. Obase Y, Matsuse H, Shimoda T, Haahtela T, Kohno S. Pathogenesis and management of aspirin-intolerant asthma. Treat Respir Med 2005; 4: 325–36.
National Asthma Council Australia
5. Thien F. Asthma. Its phenotypes and the influences of analgesics. Aust J Pharmacy 2007; 88: 76–80.
retained editorial control.
6. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004; 328: 434.
7. Thien FC. Drug hypersensitivity. Med J Aust 2006; 185: 333–8.
Developed in consultation with Associate Professor Frank Thien,
respiratory physician and allergist, and Dr Jenny Gowan, pharmacist.
8. Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma.
Disclaimer: Although all care has been taken, this resource is not intended
Eur Respir J 2000; 16: 432–6.
to be a substitute for individual medical advice/treatment. The National
9. Debley JS, Carter ER, Gibson RL, Rosenfeld M, Redding GJ. The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled
Asthma Council Australia expressly disclaims all responsibility (including
bronchoprovocation challenge study. J Pediatr 2005; 147: 233–8.
for negligence) for any loss, damage or personal injury resulting from
10. Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol 2006; 533: 145–55.
reliance on the information contained herein.
© 2009 National Asthma Council Australia
Pain relievers and asthma: quick reference guide
Questions to ask every person requesting pain reliever medication
Is this medication NO Find out who the medication is for. YES REfER tO
for you? Is this medication for a child or PhARmACISt
breastfeeding/pregnant woman,
or is it a S3 request?
YES NO
Ask questions about
patient not purchaser
Do you have any health problems NO SUPPLY AS All pain relievers*
such as asthma, diabetes, high blood USUAL can be considered
pressure, heart or kidney problems?
YES, asthma YES, other REfER tO Usual counselling
PhARmACISt protocols apply
SUPPLY AS ONLY if medication is
Is the medication requested low-dose YES, repeat USUAL already being taken
aspirin for cardiovascular protection?
NO YES, first time REfER tO Usual counselling
PhARmACISt protocols apply
Have you ever had rhinitis or asthma YES REfER tO Advise AGAINSt use
symptoms 1-3 hours after taking PhARmACISt of aspirin or NSAIDs
†
aspirin or any other pain reliever
medications? Symptoms include
runny or blocked nose, itchy throat, Have you ever had asthma symptoms
wheezing or chest tightness after taking paracetamol?
NO / don’t know NO YES
Refer patient to
Recommend paracetamol but advise
doctor to obtain
against high doses (>1000mg).
alternative analgesia
Recommend patient discuss with doctor
n REfER tO Aspirin or NSAIDs can
Do you have: Nasal polyps? YES, any
n PhARmACISt be used with caution
Long-term or recurring rhinitis?
n
Skin rashes due to allergies?
n
Severe asthma?
Advise the patient to follow their written asthma action plan.
Intolerance is unlikely if aspirin or NSAIDs have been taken
NO
in the last 6 months without causing any asthma symptoms
SUPPLY AS Intolerance is unlikely. Aspirin or NSAIDs can
USUAL be used with very low risk of an asthma reaction
NSAIDs: Nonsteroidal anti-inflammatory drugs.
*Provided that no other contraindications or precautions apply.
†Check with the Pharmacist which NSAIDs are sold over the
counter in your pharmacy so that you recognise them.
© 2009 National Asthma Council Australia
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