The causative agent of aspirin asthma isNon-steroidal anti-inflammatory drugs that help narrow the bronchi. NSAIDs also include aspirin, or acetylsalicylic acid, which is used as an analgesic and anti-inflammatory agent. Very often, aspirin asthma is combined with infectious bronchial asthma (9-22% of patients suffer from two types of asthma), but it can also exist in its pure form. Aspirin asthma is not a congenital, but an acquired disease. Symptoms of aspirin asthma mainly appear after atopic bronchial asthma, so children do not suffer from it. In most cases, women aged 30-50 years are affected. Symptoms include severe nasal congestion and rhinitis, and as a result, decreased sense of smell and headache. Then polyps appear in the nose and sinuses, followed by attacks of suffocation and intolerance to NSAIDs.

The mechanism of development of aspirin asthma

The reason is the interference of aspirin inmetabolism of arachidonic acid, which is contained in the cell membrane. In a healthy state, this acid, under the influence of the enzyme cyclooxygenase, turns into a compound that helps trigger an inflammatory reaction. And NSAIDs in this situation block the enzyme, preventing it from developing. In patients with aspirin asthma, the cyclooxygenase enzyme has a defect and the body uses another, lipoxygenase, which converts arachidonic acid into leukotrienes, which contribute to bronchial edema and sputum production. As a result, symptoms of aspirin bronchial asthma begin to appear.

Why abstain from aspirin asthma?

The patient should not take medicationspyrazolone series: theofedrine, analgin, spazmalgon, baralgin, amidopyrine, tempalgin, reopyrin, aspirin and other NSAIDs, as well as drugs that contain them: diclofenac, indomethacin, ibuprofen, sulindac, piroxicam, naproxen, etc. If necessary, paracetamol, solpadeine, tramadol (or tramal), phenacetin can be taken as a pain and fever reliever. Along with the listed drugs, aspirin bronchial asthma can manifest itself from the presence of the yellow dye tartrazine in food (both in food and in drugs). In its chemical composition, it is similar to aspirin. Patients should not consume confectionery products and alcoholic beverages of yellow color (they contain tartrazine). Salicylates are also harmful: natural (tomatoes, raspberries, oranges, black currants, plums, cucumbers, apricots, cherries), industrial (canned food and delicatessen). Natural salicylates contain tartrazine in small quantities, so they rarely cause an attack. The production of histamine is dangerous for the patient, this process is provoked by citrus fruits, fish, fresh cabbage.

Take urgent measures

Sometimes a person does not suspect the presence of this disease in himself and takes aspirin. If the first symptoms appear (after 5-10 minutes a runny nose, cough, difficulty breathing begins), it is necessary:

• rinse the stomach: drink 1 liter of boiled water, then press the root of the tongue to clean the stomach. If the tablet pops up, then follow-up actions are not necessary;
• drink 10 tablets of activated carbon and antihistamine tablets (tavegil, suprastin, claritin, etc.);
• when the attack passed, you need to make an appointment with an allergist.

How to detect aspirin bronchial asthma?

Aspirin-induced asthma can be diagnosed by:special in vivo tests are carried out. Under the supervision of an allergist with special equipment (in case of an attack), the patient is given aspirin (or another drug related to NSAIDs). A test was conducted, in which 100 people participated: a third of the subjects did not have symptoms of aspirin asthma, the second third had bronchospasm, which was sometimes not even clinically recorded, and only the remaining third had a serious reaction to the drug. In vitro tests are carried out, but in this case there is no risk of an attack, since the reaction studies are carried out with blood cells (it is necessary to simply donate blood). The reaction to NSAIDs can manifest itself in any part of the respiratory system, and in some cases the intestines, stomach and other mucous membranes can be affected. This also has a negative effect on the immune system, which manifests itself in the form of severe and protracted inflammatory diseases.

Desensitization as the main method of treatment

Desensitization is one of the waystreatment of aspirin asthma, based, like in vivo tests, on provocation, only in small doses for a certain time. Treatment must be carried out in a dispensary under the supervision of specialists using all the necessary equipment. For example, at intervals of 30 minutes, the patient is given aspirin with a constant increase in dose: 3, 30, 60, 100, 150, 325 and 650 mg. But this quick method is quite harsh, which usually ends with an attack of suffocation. Therefore, it is better to increase the dose after 24 hours. Before desensitization, it is necessary to relieve an exacerbation of asthma and check for contraindications, which are: pregnancy, bleeding, gastric ulcer or duodenal ulcer. Inhalations are carried out not only as a basic method, but also in the case of ulcerative disease of the duodenum or stomach (in this case, aspirin-lysine injections can also be used). Aldecin (USA) is very convenient to use, as it has a removable nasal attachment, which is very important for polypous rhinosinusopathy. Surgery further develops symptoms and complicates the disease. If the patient does not tolerate desensitization, hemosorption is carried out for a week and then desensitization again. If the symptoms of the disease are weak, then hemosorption can completely cure a patient suffering from aspirin bronchial asthma. After recovery in the hospital, the patient is prescribed a maintenance course of treatment on an outpatient basis, the essence of which is regular intake of aspirin for a year after meals, washed down with alkaline mineral water, under strict medical supervision.

Leukotriene antagonists

Treatment with antileukotriene drugs -This is a treatment with antagonists (translated from Greek as "opponent") of leukotrienes. But along with inhaled hormonal agents, it is recommended to use tablets. About 20 years ago, many companies began developing antileukotrienes in two directions: inhibitors (substances that suppress any reaction) of leukotriene synthesis and substances that bind leukotriene receptors (like antihistamines). A huge number of compounds were synthesized, but only four of them are active: zileutone (the first direction); zafirlukaste, montelukaste and pranlukaste (the second direction). But as it turned out in practice, aspirin asthma was not completely cured, only the number of additional drugs and the number of attacks decreased. Leukotriene drugs are still under development. They belong to a group of drugs that help control aspirin-induced bronchial asthma and are used concomitantly in the treatment of patients.

Hemosorption and laser irradiation of blood

Complex and severe aspirin bronchialAsthma is treated by a combination of hemosorption and intravenous laser blood irradiation. The essence of hemosorption is the removal of toxic or pathological substances from the body by the influence of a sorbent outside the body. Laser blood irradiation (photohemotherapy, intravascular laser blood irradiation, ILOC) is a method of efferent therapy (extracorporeal detoxification, gravitational blood surgery), which consists of a dosed effect of low-intensity lasers. The ILOC method affects the processes of the subcellular and cellular levels, therefore, the normal functioning of tissues and organs is restored. It is important that foreign substances are not introduced into the body to affect any individual link in the development of the disease, but only the self-regulation system of the body is corrected. Therefore, this method is very effective, universal and safe. ILOC is done every day (or every other day), the course is determined by the doctor and is on average from 3 to 10 procedures. The procedure takes 15-20 minutes. Laser blood irradiation is painless.

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