Evaluating the Safety of Non-Steroidal Anti-inflammatory Drugs use in Asthmatic Patients: A Systematic, Critical Review of Literature

Abstract

Background: Evidence suggest avoidance of Non-steroidal anti-inflammatory drugs (NSAID) in aspirinintolerant
asthmatics due to the risk of triggering exacerbation attack; however, evidence around avoiding
NSAIDs in all other asthmatic patients are unclear. This study aimed to evaluate the evidence surrounding
the safety of using NSAIDs, including selective COX-2 inhibitors, among asthmatic patients.
Methods: A systematic review used Medline (OVID), Scopus and Embasefrom January-2008 to
January-2019. Inclusion criteria includedEnglish, and human studies that evaluated the use of NSAID in
asthmatics. Data was screened/extracted using a pre-designed data extraction form using Covidence®,
thenwere critically appraised.
Conclusion: Of the 49 identified studies,eight were eligible. Prevalence of NSAID-induced asthma
exacerbation was 9%(95%CI:6.0–12.0%)-9.9% (95%CI:9.4-10.5%). Asthmatics who were aspirin/NSAID
intolerant had 37% higher risk of hospitalisation compared to tolerant patients (RR:1.37; 95%CI:1.12–
1.67).Use of COX-2 inhibitors showed non-significant associations with worsening respiratory symptoms/
exacerbation. Only low-quality evidence was found for the safety of topical NSAID. NSAIDs-induced
respiratory reactions/symptoms is relatively uncommon with the majority of asthmatic patients could
tolerate NSAIDs therapy. Asthmatic patients who suffer from aspirin-induced asthma or NSAIDsexacerbated
respiratory disease (NSAIDs intolerant) should be avoided NSAIDs prescribing but could be
safely prescribed selective COX-2 inhibitors as an alternative.