The protective effects of leukotriene modifiers in aspirin-induced asthma.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase activity and, in aspirinintolerant patients, can precipitate life-threatening asthma attacks. In aspirin-sensitive asthmatic patients, exposure to aspirin results in a dramatic increase in cysteinyl leukotriene production, the precise mechanism of which remains unclear. However, clinical studies of the 2 types of leukotriene modifiers--the leukotriene synthesis inhibitors and the leukotriene receptor antagonists (LTRAs)--have established the critical pathogenic role played by leukotrienes in aspirin-induced asthma (AIA). Zileuton, the only leukotriene synthesis inhibitor now available, increased pulmonary function and alleviated the cardinal signs of AIA. Montelukast, a potent LTRA, blocked the airway obstruction induced by lysine-aspirin inhalation in aspirin-sensitive asthmatic patients. Pulmonary function improved significantly, and both ss-agonist use and frequency of nocturnal awakening decreased. Pranlukast, a LTRA available only in Japan, produced results similar to those reported for montelukast. Despite these agents' protective effects, aspirin-sensitive asthmatic patients should be cautioned to avoid the use of any drug that inhibits cyclooxygenase activity.
Israel
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Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001249:Asthma; D055963:Asthma, Aspirin-Induced; D006801:Humans; D020024:Leukotriene Antagonists; D015289:Leukotrienes
D000894:Anti-Inflammatory Agents, Non-Steroidal; D020024:Leukotriene Antagonists; D015289:Leukotrienes