Aspirin induced asthma
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《英国医生杂志》
EDITOR—We agree with Sivanandan and Robinson that the recommendation to organise a test before administration of aspirin would be difficult in routine clinical practice. Our advice regarding formal provocation testing and medical supervision for the first dose is simply to maximise safety. When this is not possible, clear advice should be given about the risks, and the availability of bronchodilators should be ensured. The onset of aspirin induced bronchoconstriction occurs within one hour, and in our experience the worst reactions occur within two hours.
We concur that the converse of our findings is that four out of five patients with asthma are safe with respect to risk of sensitivity to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). This is reassuring, and it is important not to over-react by saying that all asthmatic patients should avoid aspirin or NSAIDs. In view of the high prevalence of asthma in the community and the likelihood of occasional purchase of over the counter simple analgesics, we believe simple, standardised warnings on packs of aspirin and NSAIDs are appropriate.
We agree with Southward that there is heterogeneity of study populations in our meta-analysis. We tried to overcome this by grouping subjects according to the clinical history. Most of the patients were selected from tertiary hospital outpatient clinics and almost certainly represent a group of patients with more severe asthma than patients who never present to hospital. More studies are required to determine the prevalence and severity of aspirin sensitive asthma in the total asthma population.
Christine Jenkins, head, asthma group
Woolcock Institute of Medical Research, Camperdown, NSW 2050, Australia crj@mail.med.usyd.edu.au
John Costello, clinical director of medicine
King's College Hospital, London SE5 9RS
Linda Hodge, dietitian
Clontarf, NSW 2093, Australia
Competing interests: CJ has received payment from GlaxoSmithKline Consumer Healthcare Australia, the manufacturer of Panadol (paracetamol), for speaking at a conference. JC serves as a consultant on the Global Analgesics Advisory Board, which is funded by GlaxoSmithKline Consumer Healthcare.
We concur that the converse of our findings is that four out of five patients with asthma are safe with respect to risk of sensitivity to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). This is reassuring, and it is important not to over-react by saying that all asthmatic patients should avoid aspirin or NSAIDs. In view of the high prevalence of asthma in the community and the likelihood of occasional purchase of over the counter simple analgesics, we believe simple, standardised warnings on packs of aspirin and NSAIDs are appropriate.
We agree with Southward that there is heterogeneity of study populations in our meta-analysis. We tried to overcome this by grouping subjects according to the clinical history. Most of the patients were selected from tertiary hospital outpatient clinics and almost certainly represent a group of patients with more severe asthma than patients who never present to hospital. More studies are required to determine the prevalence and severity of aspirin sensitive asthma in the total asthma population.
Christine Jenkins, head, asthma group
Woolcock Institute of Medical Research, Camperdown, NSW 2050, Australia crj@mail.med.usyd.edu.au
John Costello, clinical director of medicine
King's College Hospital, London SE5 9RS
Linda Hodge, dietitian
Clontarf, NSW 2093, Australia
Competing interests: CJ has received payment from GlaxoSmithKline Consumer Healthcare Australia, the manufacturer of Panadol (paracetamol), for speaking at a conference. JC serves as a consultant on the Global Analgesics Advisory Board, which is funded by GlaxoSmithKline Consumer Healthcare.