Aashi
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A 47-year-old man presents to your office complaining of progressively worsening episodes of shortness of breath. He has a history of asthma that has been well controlled with inhaled steroids, which he takes daily, and an albuterol inhaler, which he only needs to take approximately once to twice per month. He was hospitalized 6 weeks ago for new-onset stable angina and was discharged with sublingual nitroglycerine and low-dose aspirin, which he takes daily. Shortly after his discharge, he states that he began having increasing nasal and sinus congestion, which soon progressed to episodes of wheezing, dry cough, and shortness of breath. He is now having these episodes about four times a week. In addition, he has had these symptoms at night three times in the past month. On physical examination, patient is afebrile, and lung examination reveals prolonged expiration with bilateral expiratory wheezes. He has nasal polyps. The peak expiratory flow is 85% of predicted. Which of the following would be the most appropriate management of this patient's condition?
(A) Increased dose of inhaled steroids
(B) Add a long-acting beta-agonist
(C) Add theophylline
(D) A short course of oral steroids tapering over 4 weeks
(E) Add a leukotriene modifier
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| robin082006
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E
this is Aspirin induced asthma
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| prathapdoctor
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I agree with robin, answer is E.
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| fox
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agree that this is sampter's triad.....but what are leukotriene modifiers & how they prevent aspirin from exterting its effect. Please clarify.
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| prathapdoctor
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because aspirin is an irreversible inhibitor of cycloxygenase, which leads to decreased production of prostaglandins from arachanoid acid, but the enzyme lipoxygenase is uneffected by aspirin, so there will be excessive production of leukotrienes through lipoxygenase activity from arachadonic acid.
leukotriene synthesis inhibitor is ZILEUTON
leukotriene receptor inhibitors are ZAFIRLUKAST AND MONTELEUKAST
in this way above drugs are effective in aspirin induced asthma.
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| fox
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thanks!
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| Aashi
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Ans is E
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