People with diagnosed or suspected aspirin-induced asthma should avoid all NSAIDs, including COX-2 selective NSAIDs. Aspirin-induced asthma typically appears in adulthood and is often preceded by the development of persistent rhinitis. Asthma symptoms occur within three hours of taking an NSAID.^1,2

Prevalence estimates in adults with asthma vary between 5% and 20 per cent.^2-4

Paracetamol is usually preferred over NSAIDs because of its efficacy and superior safety profile. Only a very small proportion of patients with aspirin-induced asthma have symptoms triggered by paracetamol.^3,5

Other people with asthma may be advised to seek medical advice if their asthma symptoms worsen after taking an NSAID.

Previous exposure to NSAIDs is not required for aspirin-induced asthma to develop. In addition, some patients may not recognise that NSAIDs exacerbate their asthma because of the time delay between exposure and symptoms.

REFERENCES
1. Thien F, Armstrong D, Gowan J, Rudolphy S. Asthma and pain relievers: an information paper for health professionals. South Melbourne: National Asthma Council, March 2005 (accessed 15 June 2006).

2. Hamad A, Sutcliffe A, Knox A. Aspirin-induced asthma: clinical aspects, pathogenesis and management. Drugs 2004;64:2417-32.

3. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328:434.

4. Morwood K, Gillis D, Smith W, Kette F. Aspirin-sensitive asthma. Internal Medicine Journal 2005;35:240-46.

5. Settipane R, Stevenson D. Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma. Journal of Allergy and Clinical Immunology 1989;84:26-33. Adopted from www.medicalobserver.com.au