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Understanding Aspirin Sensitivity and its Impact on Respiratory Health

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Zara Nwosu
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Understanding Aspirin Sensitivity and its Impact on Respiratory Health

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Aspirin sensitivity, also known as aspirin-exacerbated respiratory disease (AERD), can be triggered by aspirin and aspirin-like drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. This condition can cause respiratory symptoms and is a significant concern for individuals with asthma. Understanding the triggers and symptoms of aspirin sensitivity is crucial for effective management and treatment.

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What is Aspirin Sensitivity?

Aspirin sensitivity can trigger preexisting asthma and result in sinus or skin reactions. About 29 million people in the U.S. alone take aspirin every day. Aspirin sensitivity can be triggered by aspirin-like drugs such as ibuprofen and naproxen, causing exacerbation of asthma, nasal sinus symptoms, and skin reactions. Aspirin sensitivity can take the form of aspirin-exacerbated respiratory disease (AERD), chronic urticaria, or anaphylaxis. Tolerance to aspirin can be induced via aspirin desensitization, improving the course of asthma and chronic sinusitis. There is no skin test or blood test to predict adverse reactions to aspirin, and an aspirin challenge must be done by an experienced team at a well-equipped facility. Patients with adverse reactions to aspirin should talk to a healthcare provider about their sensitivity, especially if they have preexisting conditions or heart disease.

Aspirin Sensitivity and Cardiovascular Disease

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A recent retrospective review of US claims data found a significant association between AERD and Atherosclerotic Cardiovascular Disease (ASCVD), including serious ASCVD, compared to other groups with asthma. This study highlights the importance of early detection of ASCVD and considering aspirin desensitization or alternative antiplatelet drugs for patients with AERD and ASCVD.

Safety and Tolerability of Respiratory Drugs

Adverse events associated with drugs that act on the respiratory tract, including leukotriene modifiers, anticholinergic drugs, anti-fibrotic therapies, and monoclonal antibodies, are crucial to consider in patients with conditions like AERD. These insights are particularly relevant for pediatric patients, Asian patients, and those with conditions like Covid-19 pneumonia and severe asthma.

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Aspirin Sensitivity and Asthma

Aspirin sensitivity and its impact on respiratory health is a serious concern for those with asthma. Ibuprofen and other NSAIDs can cause allergic reactions in people with asthma, with symptoms ranging from mild to severe. About 20% of people with asthma are sensitive to ibuprofen and other NSAIDs. Additionally, those with asthma, NSAID intolerance, and nasal polyps can have a life-threatening condition known as AERD. Alternative medications and treatments, such as acetaminophen and non-medication options like ice packs, are available for those with asthma who are sensitive to NSAIDs. It's important for individuals with asthma to be aware of the risks associated with ibuprofen and other NSAIDs, and to consult with their doctors for alternative pain management options.

Challenges in Aspirin Use and Guidelines

Two single-center retrospective studies found that a significant portion of patients were inappropriately taking aspirin. The first study found that only 20.4% of patients on dual antithrombotic therapy were deprescribed aspirin as per the 2023 American Heart Association Chronic Coronary Disease guidelines. The second study found that 18.4% of older patients were using aspirin for primary prevention of cardiovascular disease before a 2022 recommendation was issued to not initiate aspirin in this age group. After the recommendation, 17.7% of patients continued to use aspirin for primary prevention. Both studies highlighted the challenges in implementing guideline recommendations for aspirin use, and suggested that pharmacist-led interventions could help improve guideline concordant aspirin use.

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