Aspirin, development history

The development of aspirin was a significant landmark in the history of medicine because it stimulated the development of a family of medicines, collectively known as the nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs such as ibuprofen, naproxen, and sulindac are valuable drugs used for the alleviation of pain, inflammation, and fever, and they are commonly prescribed for the treatment of rheumatoid disorders such as arthritis. The world market for NSAIDs now exceeds 6 billion (Vainio and Morgan, 1997). 

A 74-year-old woman had a 3-year history of mild dysarthria, dizziness, and gait ataxia, accompanied by two transient ischemic attacks with involuntary ballistic movements of her left arm lasting several seconds each, and another transient ischemic attack with a right homonymous hemianopia lasting 30 minutes. About 45 minutes after her first-ever oral administration of dipyridamole plus aspirin she developed a transient cerebellar deficit that reproduced features of previous vertebrobasilar ischemic events, as well as severe headache, flushing, and diarrhea. 

I developed a chest pain on and off so I stopped a doctor in the hall at work and explained my fear of heart problems because of my family history of heart disease. He said it was probably pleurisy and the first step of treating Lupus was to take aspirin on a regular basis. 

In addition to skin eruptions aspirin can cause a syndrome referred to as aspirin exacerbated respiratory disease (AERD) in which the classic triad of asthma, rhinitis, and aspirin sensitivity was first described by Sam ter. It is important to note that AERD has as its precursor an underlying respiratory disease such as asthma that is exacerbated by aspirin but not caused by aspirin. Briefly, the natural history of this disease indicates that the patient first develops an upper respiratory tract inflammation that persists rather than subsides. Sinusitis develops, which progresses to pansinusitis with nasal polyps and asthma noted. At some point the patient takes aspirin or some other COX-1 inhibitor and an AERD reaction occurs. Although this is truly an idiopathic reaction to NSAIDs, adult patients with chronic sinusitis and nasal polyps should be observed carefully for the potential development of AERD. 

Ibuprcfen is thought to be better tolerated than aspirin and indomethacin and has been used in patients with a history of gastrointestinal intolerance to other NSAIDs. Nevertheless, 5-15% of patients experience GI side effects. Less frequent adverse effects include thrombocytopenia, rashes, headache, dizziness, blurred vision, and in a few cases toxic amblyopia, fluid retention, and edema. Patients who develop ocular disturbances should discontinue the use of ibuprofen. Ibuprofen can be used occasionally by pregnant women however, the concerns apply regarding third-trimester effects. Excretion into breast milk is thought to be minimal, so ibuprofen also can he used with caution by women who are breastfeeding. 

Based on in vitro data, anagrelide eould have additive effeets with drugs that inhibit platelet function, such as aspirin although in clinical development no such effects were observed. Nevertheless, the manufacturer recommends that the risk/benefit ratio should be assessed before aspirin in used with anagrelide in patients with a high platelet count (greater than 1500 X QpfL) and/or a history of haemorrhage. ... 

The natural history of aspirin-induced asthma, or aspirin triad, begins with ihinorrhea and nasal congestion. This proceeds to rhinitis which becomes perennial and associated with chronic sinusitis and nasal polyps. Asthma develops 1-5 years after the onset of rhinitis. The disease usually appears at an age of 30-34 years and its course is usually more severe and progressive in women who outnumber men. 

Rainsford, K. D. History and development of the salicylates. (2004) In Aspirin and Related Drugs (K.D. Rainsford, ed.), Taylor Francis, London/New York, pp. 1-23. 

---