[Analgesic asthma].

Abstract

Analgesics-induced asthma (AIA) is quite often unidentified and then is a severe danger to the patients affliced. In a case-control-study 1042 asthmatic patients selected by random were investigated. In 18.9% of patients the presence of AIA was recorded. Woman accounted for 71% of the AIA patients. Coincidence of AIA with nasal polyposis, paranasal sinus diseases, chronic rhinitis, alcohol intolerance and severe bronchial asthma was recorded with high significance. Chronic hyperplastic changes in the upper airways were exhibited by about 64% of the AIA patients. AIA is a non-allergic form of asthma, resembling immediate allergic type I reaction. Analgesics-based acute bronchoconstriction will typically develop within 45 min. following intake of the analgesic. Triggering threshold doses may differ strongly by individuals. Oral exposure test is connected with a high risk of complications. A case history usually is sufficient for save diagnosis. Analgesics without inhibiting action on cyclooxygenase usually are tolerated. The causes of AIA should be ascribed to changes in the release and conversion of arachidonic acid (Aa) from membrane phospholipids. The inhibition of Aa release (phospholipase-A2-reaction) by protease inhibitors or the inhibition of Aa transformation to bronchoconstrictive lipoxygenase products by lipoxygenase inhibitors were shown in vitro (isolated guinea pig lung strips and human bronchi). Paraaminomethylbenzoic acid also was found to be effective in clinical experiments preventing analgesics-induced bronchoconstriction. Both seem to be principal ways for modulation of bronchoconstriction.