Aspirin induced asthma

Editor—The prevalence of aspirin induced asthma on oral provocation testing in the systematic review by Jenkins et al was determined at 21%, which is noticeably higher than verbal history (2-3%) and recent reviews (10%).^1-3 The clinical relevance of this finding is not explained. What was the degree of bronchospasm? In how many patients was it easily reversed by a dose of inhaler?

Figure 1.

Credit: BAYER AG

As anaesthetists we agree fully with the authors' recommendations about the dangers of giving non-steroidal anti-inflammatory drugs (NSAIDs) to patients with known sensitivity to aspirin. We also recognise that people with nasal polyps and asthma are at higher risk of aspirin sensitivity. It is the large proportion of patients who are left for whom we have an issue.

The recommendation to organise a test before administration would be difficult in the current NHS. The authors' guidelines recommend that anyone younger than 40 should have a trial of drug treatment under supervision, or should be prescribed an NSAID only if absolutely necessary. This could be accommodated postoperatively in hospital, but not when NSAIDs are given to patients to take home—for example, after day case surgery. How long do Jenkins et al recommend the patients be observed for?

We do not want this paper to cause anaesthetists, emergency doctors, and surgeons to deny these useful drugs to patients with asthma. A balanced approach taking into account risks and benefits is always necessary. This review, even with the admission of bias in the paper, shows that 80% of asthmatic patients can take these drugs.