Respiratory reactions, NSAID

The mechanism of NSAID-induced respiratory reactions appears to be due to the redirection of arachidonic acid metabolism from the COX to the lipoxygenase synthetic pathway with associated production of cysteinyl leu-kotrienes. PGE2 normally helps to dampen the production of the leukotrienes. 

Reactions not mediated by IgE but produced by a pharmacologic reaction predominantly by the NSAID inhibitors COX-1 and -2 which can cause respiratory, skin or both types of reaction or severe anaphylaxis. These are the most frequent types of reaction. To date, only BAT has been validated as an in vitro diagnostic test with contrasted usefulness. In the best argued study [32], sensitivity of the test... 

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. 

However, the manttfachtrer of meloxicam contraindicates its ttse in patients who are serrsitive to aspirin or NSAIDs. Seventy-seven rherrmatol-ogy patients with a history of asthma cattsed by aspirin or a NSAID and given ascending doses of etoricoxib 60 to 120 mg daily for 3 days had no respiratory or cutaneorrs reaction to etoricoxib even after rechallenge 5 days later. ... 

Absolute contraindications for both opioids and NSAIDS include hypersensitivity reactions, such as development of shortness of breath, severe rash, etc. Oxycodone and hydrocodone are contraindicated in patients with risk for significant respiratory depression. Because of the inhibition of GI motility by narcotic medications, oxycodone and hydrocodone are contraindicated in the setting of paralytic ileus. 

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