by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Australian Journal of Pharmacy : October 2006
Can other analgesics trigger aspirin induced asthma? “Yes. Patients whose asthma can be triggered by aspirin are usually cross-sensitive to all other NSAIDs.2 ” This is related to their ability to inhibit cyclooxygenase and thus prostaglandin biosynthesis.2,7 “In contrast, paracetamol has only a weak inhibitory effect on cyclooxygenase and is therefore less likely to induce an asthma attack in people who have aspirin induced asthma.2 If a person were to react to paracetamol in this way, they would also be extremely sensitive to aspirin and NSAIDs.2 ” • The meta-analysis of studies in which patients underwent oral provocation tests found that: – 98%, 100% and 93% of people with aspirin induced asthma were also cross-sensitive to OTC doses of ibuprofen, naproxen and diclofenac, respectively.3 – But only 7% of people with aspirin induced asthma were also cross-sensitive to paracetamol.3 • Based on this data, less than 2% of adult patients with asthma are sensitive to paracetamol, compared to approximately 20% with ibuprofen, naproxen or diclofenac3 (See Figure 1). • If a person is sensitive to paracetamol, the asthmatic reactions tend to be milder than those induced by aspirin (they are of shorter duration and require less bronchodilator treatment to reverse).8 Figure 1. Estimated prevalence of sensitivity to OTC analgesics amongst people with asthma. Adapted from Jenkins 2004.3 14 16 18 20 10 12 0 2 4 6 8 19.6 20 18.6 How can we promote the appropriate use of analgesics in susceptible patients? “Whilst the vast majority of people who use OTC analgesics derive much benefit from them,9 consumers still need to be educated to ensure they know which product is most suitable for them and their pain state.” “By taking an active role in asking people about asthma and advising them about the potential for aspirin induced asthma, healthcare professionals are in a unique position to reinforce the quality use of these medicines.” Questions to consider before recommending an analgesic to a person with asthma.* 1. Assess whether the person is aware of aspirin sensitive asthma • Do you have aspirin induced asthma? (or has a doctor ever told you that you have aspirin sensitivity?) • Have you ever had an asthma attack shortly (i.e. within 3 hours) after taking aspirin or NSAIDs? • Have you ever experienced asthmatic symptoms after taking paracetamol? 2. Assess whether the person has high risk factors for aspirin sensitive asthma • Is your asthma severe? (or how frequently do you need to use your asthma inhaler?) • Do you have urticaria, nasal polyps or chronic rhinitis? 3. Assess recent analgesic use • Have you taken aspirin or an NSAID recently? * Before recommending an analgesic: • Check for other medical conditions and interactions with concomitant therapies. • Patients must satisfy all normal precautions and contraindications for use. Due to the low prevalence of sensitivity, paracetamol is the analgesic and antipyretic of first choice amongst patients with asthma;3 and is considered to be a suitable analgesic for patients with suspected or diagnosed aspirin induced asthma.1-3 BROUGHT TO YOU BY THE MAKERS OF PANADOL® IN THE INTEREST OF THE QUALITY USE OF MEDICINES. PANADOL® CONTAINS PARACETAMOL. USE PANADOL® TEMPORARY RELIEF OF PAIN AND FEVER. PANADOL® IS A REGISTERED TRADE MARK OF THE GLAXOSMITHKLINE GROUP OF COMPANIES. GLAXOSMITHKLINE CONSUMER HEALTHCARE, 82 HUGHES AVENUE, ERMINGTON NSW 2115. [SCIUS:GS189] 1.4 Ibuprofen (=400 mg) Naproxen (=100 mg) Diclofenac (=40 mg) Paracetamol (=1600 mg) REFERENCES: 1. Thien FC, Armstrong D, Gowan J, Rudolphy S. Asthma and Pain Relievers: An information paper for health professionals. 2005. Australia, National Asthma Council. 2. Jenkins C. Recommending analgesics for people with asthma. Am J Ther 2000; 7(2):55-61. 3. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004; 328(7437):434. 4. Szczeklik A, Nizankowska E. Clinical features and diagnosis of aspirin induced asthma. Thorax 2000; 55(Suppl 2):S42-S44. 5. Zeitz HJ. Bronchial asthma, nasal polyps, and aspirin sensitivity: Samter’s syndrome. Clin Chest Med 1988; 9(4):567-576. 6. Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002; 57(7):569-574. 7. Morwood K, Gillis D, Smith W, Kette F. Aspirin-sensitive asthma. Intern Med J 2005; 35(4):240- 246. 8. Settipane RA, Schrank PJ, Simon RA, et al. Prevalence of cross-sensitivity with acetaminophen in aspirin-sensitive asthmatic subjects. J Allergy Clin Immunol 1995; 96(4):480- 485. 9. Bandolier. OTC analgesics - what do people use? Moore A, McQuay H, editors. Bandolier 106 (Volume 9, Issue 12). 2002. Oxford, UK. OGILVY HEALTHWORLD GSKP0047 FOR THE Prevelance of sensitivity (%)