Three types of special asthma

Aspirin and drug – induced asthma, exercise-induced asthma, menstrual asthma understand ~
Bronchial asthma (asthma) is a heterogeneous disease, is by a variety of cells and cell components involved in chronic inflammatory airway disease, clinical performance for recurrent wheezing, cough, shortness of breath, chest tightness, often during the night and (or) early morning attack or worse, the pathologic physiology is characterized by chronic airway inflammation, high reactivity and airway remodeling.
The drugs used to treat asthma are glucocorticoids, beta2-receptor agonists, leukotriene receptor antagonists (LTRA), theophylline drugs, anticholine drugs, and anti-ige monoclonal antibodies.
So, what about aspirin and drug-induced asthma, exercise-induced asthma, and menstrual asthma?
Aspirin and drug-induced asthma
Drug-induced asthma (DIA) is an asthma attack caused by the use of certain drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), blood pressure lowering drugs, anticholine drugs, beta blockers, antibiotics, contrast agents, and biological agents.
Aspirin asthma (AIA) is an inflammatory disease characterized by airway hyperresponsiveness and involving the upper and lower airways. It is an NSAIDs intolerance to aspirin and other NSAIDs, characterized by nasal congestion, runny nose, acute attacks of asthma and recurrent nasal polyps within a few minutes to 1-2 h after taking aspirin.
AIA may be due to the deficiency of phospholipid A2 enzyme or aspirin, which may inhibit the degradation of arachidonic acid, inhibit the metabolism of cyclooxygenase, and instead make the degradation of 5-lipase a dominant pathway, leading to the formation of large amounts of cysteamylleukotriene.
AIA presents with chronic rhinosinusitis (CRS) associated with nasal polyps and refractory asthma in the lower airway.
Typical clinical manifestations are severe asthma attacks after taking aspirin and other NSAIDs for 10-120 min, often accompanied by cyanosis, conjunctival congestion, sweating, sitting breathing, irritability or cough, and even shock, loss of consciousness and respiratory arrest in severe cases.
Aspirin asthma is associated with reduced lung function and severe asthma, with an incidence of 7% in adults and 15% in severe asthma.
A history of asthma after taking aspirin or other NSAIDs suggests aspirin asthma.
DIA can be effectively prevented by avoiding as far as possible the use of drugs that may induce asthma attacks, such as aspirin or other NSAIDs. When NSAIDs are used due to illness, COX inhibitors such as cakebacker or acetaminophen are recommended and observed for at least 2 h after administration.
In addition, aspirin containing food and drinks should be banned to prevent AIA outbreak, such as pigment additives or preservatives such as yellow dye (tartrazine) added saccharin, cyclitin, white wine, etc.
Inhaled glucocorticoids (ICS) are the primary drug used to treat aspirin asthma, sometimes with short-term oral corticosteroids, or with leukotriene receptor antagonists (LTRA) such as Montelulast, and nasal disease control can also help improve aspirin asthma symptoms.
Desensitization is recommended for aspirin asthma patients who need high doses of glucocorticoids to control asthma symptoms, or who are unable to improve nasal inflammation and polyps with conventional treatment, or who need aspirin for other conditions.
Exercise induces asthma
Exercise-induced bronchoconstriction (EIB) or exercise-induced asthma refers to transient lower airway constriction or bronchoconstriction that occurs after exercise, whether or not there is clinically recognized asthma. It is more common in asthmatics and can occur in people without asthma.
Bronchoconstriction usually occurs within 15 minutes after exercise and spontaneous remission occurs within 60 minutes.
EIB attacks are usually followed by an refractory period of about 1-3 h. Repeated exercise during the refractory period results in a decrease in bronchoconstriction in about 40-50% of patients.
The 2013 American Guidelines for Clinical Practice of exercise-induced Bronchoconstriction recommend the use of drugs to prevent EIB.
If symptoms occur only during and after exercise and there are no other risk factors for asthma attacks, inhaled short-acting beta2-receptor agonists (SABA) may be used as needed prior to exercise.
However, if SABA is used regularly more than twice a day, the protective effect of EIB will be weakened, namely, drug resistance will occur.
Leukotriene receptor antagonist (LTRA) or hypertrophy membrane stabilizer used before exercise also have protective effects.
EIB can be reduced by regular use of controlled medications such as ICS or leukotriene receptor antagonists (LTRA) in people with asthma symptoms or risk factors for asthma attacks.
The 2020 GINA Guide points out that regular use of ICS can significantly reduce EIB occurrence.
SABA, LABA and mast cell membrane stabilizer before exercise can prevent EIB, but regular use of SABA or LABA (more than once /d) will weaken the protective effect of EIB and cause drug tolerance.
Leukotriene receptor antagonists (LTRA) can partially prevent exercise-induced bronchospasm, according to the Guidelines for the Diagnosis and Prevention of Bronchial Asthma in Children (2016 edition).
Short-acting beta-2 agonist (SABA) inhalation administration may also be used as a prophylactic agent for exercise asthma.
Menstrual asthma
Menstrual asthma is a general term for pre-menstrual asthma and menstrual asthma. It is related to the onset of asthma in women and its menstrual cycle, and is related to severe asthma or refractory asthma.
According to Several Special Problems of Bronchial Asthma (2019), about one-third of female asthmatics will have exacerbations of asthma symptoms and decreased lung function during menstruation, which may be related to estrogen levels in the body.
According to the Chinese Expert Consensus on the Assessment and Management of acute attacks of Bronchial asthma (2018), the aggravation of asthma symptoms during menstruation in some women may be related to changes in hormone levels in the body.
According to the Guidelines for the Prevention and Treatment of Bronchial Asthma (2016 edition), the treatment principles of menstrual asthma are similar to those of typical asthma.
Prophylactic medications such as ketotifen (1 mg, 2 times /d) or Montelukast (10 mg, 1 time /d) may be taken orally a few days before the onset of periodic asthma.
Intramuscular injection of progesterone timely before menstruation can prevent the sudden decrease of progesterone level.
Appropriate use of acetylenediazol, for pre – tense people effective.
GINA 2020 guidelines, points out that about 20% of asthma before and after menstruation can worsen asthma, usually older, more severe asthma, a higher body mass index, and longer duration, and prone to aspirin induced increase of respiratory symptoms, also appear more dysmenorrhea, premenstrual syndrome, short menstrual cycle, menstrual bleeding time long menstrual symptoms.
It is suggested that the addition of oral contraceptives and/or leukotriene receptor antagonists (LTRA) may be helpful in addition to conventional asthma treatment strategies.

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