Nonsteroidal anti-inflammatory drugs asthma with

Voltarol is a proprietary preparation of diclofenac. Diclofenac, like all the nonsteroidal anti-inflammatory drugs, may lead to bronchoconstriction (particularly when used systemically) and therefore must be used with caution in asthma. 

Hypersensitivity to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Use extreme caution in patients with history of adverse reactions to salicylates. Cross-sensitivity may exist between aspirin and other NSAIDs that inhibit prostaglandin synthesis, and aspirin, and tartrazine. Aspirin cross-sensitivity does not appear to occur with sodium salicylate, salicylamide, or choline salicylate. Aspirin hypersensitivity is more prevalent in those with asthma, nasal polyposis, chronic urticaria. 

Nettis E, Di PR, Ferrannini A, Tursi A. Tolerability of rofecoxib in patients with cutaneous adverse reactions to nonsteroidal anti-inflammatory drugs. Ann AUergy Asthma Immunol 2002 88(3) 331. ... 

Quaratino D, Romano A, Di Fonso M, Papa G, Perrone MR, D Ambrosio FP, Venuti A. Tolerability of meloxicam in patients with histories of adverse reactions to nonsteroidal anti-inflammatory drugs. Ann Allergy Asthma Immunol 2000 84(6) 613-17. 

Aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an attack in up to 20% of adults with asthma. The mechanism is related to cyclooxygenase inhibition, and 5-hpoxygenase inhibition can prevent the symptoms. The prevalence increases with age. The greatest frequency occurs in severe corticosteroid-dependent asthmatics in their fourth and fifth decades who also have perennial rhinitis and nasal polyposis (presence of several polyps). Other drugs that do not precipitate bronchospasm but which prevent its reversal are the 8-blocking agents. ... 

All aspirin-sensitive asthmatics do not fit the classic aspirin triad picture, and not all patients with asthma and nasal polyps develop sensitivity to aspirin. In most cases, aspirin-sensitive asthmatics are clinically indistinguishable from the general population of asthmatics except for their intolerance to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin-induced asthmatics are not at higher risk of having fatal asthma if aspirin and other NSAIDs are avoided. ... 

In delivering aerosolized steroidal and nonsteroidal anti-inflammatory drugs to patients with asthma, one cell population that should be targeted is the eosinophil. This is because asthma is generally believed to involve an eosinophilic type of inflammatory reaction (25). Steroids reduce the number of eosinophils in circulation, the recruittnent of eosinophils to local tissue sites, the survival of eosinophils in the presence of cytokines, and the production of cytokines responsible for or involved in aU of these processes (25). Cromolyn inhibits the ability of eosinophils to kill complement-coated schistosomula organisms and to express, upon stimulation, complement C3b and Fey receptors (26). Nedocromil inhibits the release of proteins from eosinophil granules and leukotriene (LTC ) formation by eosinophils (27,28). 

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