Abstract

NSAIDS INDUCED PULMONARY DISORDERS - A REVIEW

Nelta S. Tharakan, Senthilraja M.* and Sambath Kumar R.

ABSTRACT

Nonsteroidal anti-inflammatory drugs (NSAIDs) are identified as the most widely prescribed and self medicated group of drugs all around the world, as they are frequently used in different age groups, for the management of inflammation, fevers and pain of different etiologies. As these drugs are exposed by a large population, makes them the second cause of unwanted reactions. NSAIDs can cause drug allergic reaction, which may includes, urticaria, less commonly pneumonitis and meningitis, angioedema, anaphylaxis and exacerbation of underlying respiratory disease. Aspirin-exacerbated respiratory disease (AERD) is a clinical factor, which includes aspirin and other NSAIDs induced respiratory reactions in practice with sinusitis, asthma and chronic rhinitis. Among the population, the prevalence of these reactions varies between 0.1% and 0.3%. As the sign and symptoms vary, the mechanisms of each of them may vary accordingly, but the mechanism of AERD can be related to arachidonic acid metabolism. The clinical spectrum of NSAIDs includes Allergic Hypersensitivity, Non-allergic Hypersensitivity, Respiratory Hypersensitivity, Cutaneous Hypersensitivity, and Non-allergic Anaphylaxis. Diagnosis can be done by collecting clinical history, Skin prick and intra-dermal tests, Patch test, photo patch tests, Basophile activation test, Lymphocyte transformation test, Aspirin-induced release of LTC4, ASPI TEST and Oral challenge test. When the patient is diagnosed as AERD, the prior management includes the limitation or complete avoidance of COX-1 inhibiting drugs or aspirin desensitization and continuous aspirin therapy. Pharmacological treatment with high-dose Corticosteroids, Antihistamines, Anti-IgE antibodies, long-acting β agonist, cysteinyl leukotrienes receptor antagonists and surgical procedures are recommended.

Keywords: Nonsteroidal anti-inflammatory drugs, Aspirin-exacerbated respiratory disease, Hypersensitivity, Cyclooxygenase, Desensitization.