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Are COX-2 Inhibitors Safe in Aspirin-Sensitive Asthma?



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Am Fam Physician. 2002 Nov 1;66(9):1760-1762.

Aspirin-induced asthma is triggered by an inflammatory response of the airways to the ingestion of aspirin and most nonsteroidal anti-inflammatory drugs (NSAIDs). This inflammatory response precipitates asthma attacks and rhinitis. Aspirin- or NSAID-induced asthma occurs in approximately 10 percent of adults with asthma and usually develops within three hours after taking one of these medications. The asthma attacks are often severe and may be life-threatening. The exact mechanism of this response is unknown but may be related to the inhibition of the cyclooxygenase (COX) enzyme. The COX-1 isoform is responsible for the production of prostaglandins. The newer COX-2 inhibitors do not affect prostaglandins and, in theory, should not precipitate an acute asthma exacerbation. Martín-García and associates studied the effect of rofecoxib, a COX-2 inhibitor, on patients with aspirin- or NSAID-induced asthma.

Patients included in the study had asthma induced by at least two different NSAIDs or aspirin. The participants were challenged with placebo and two different doses of rofecoxib on three different days. They were treated until they reached a 25-mg dose of rofecoxib or developed intolerance to the medication. If no intolerance was noted, the patients were rechallenged with 25 mg of rofecoxib seven days later. If participants developed any mucosal or skin reaction, hypotension, upper or lower airway reaction, conjunctival reaction, or laryngeal edema during the challenge test, it was considered a positive response.

All of the participants tolerated the rofecoxib challenge without any signs of immediate or delayed reactions. This included no change in spirometry measurements during the study and no significant variation in peak expiratory flow measurements. None of the participants developed any significant side effects from rofe-coxib during the challenge test.

The authors conclude that rofecoxib is suitable for use in treating inflammation in patients with aspirin- or NSAID-induced asthma. The authors caution that the study participants had asthma that was stable for at least two weeks before the use of rofecoxib, and larger studies are needed to confirm this and to determine if the other COX-2 inhibitors have a similar safety profile in these patients.

Martín-García C, et al. Safety of a cyclooxygenase-2 inhibitor in patients with aspirin-sensitive asthma. Chest June. 2002;121:1812–7.



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