Sun Wenchong, Pei Ling
Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, PR China.
J Asthma. 2011 Aug;48(6):647-9. doi: 10.3109/02770903.2011.587580.
Herein, we report a case of life-threatening status asthmaticus in a young male presented with nasal polyps but without any history of anaphylaxis or asthma.
The patient had normal results from preoperative respiratory systemic examinations. The postoperative asthma, which started after an infusion of nonsteroidal anti-inflammatory drugs (NSAIDs), was severe and difficult to manage. A relationship between the NSAID infusion and the asthma attack was indicated. Flurbiprofen axetil, a nonselective COX2 inhibitor, is most likely the causative agent in this case, although there are no prior reports of asthma caused by this agent.
We concluded that flurbiprofen axetil evoked severe bronchospasm in this case. Patients who are sensitive to flurbiprofen axetil will usually react to other NSAIDs; therefore, other ordinary NSAIDs should be used with caution in hypersensitive patients. An intranasal ketorolac challenge in individuals with nasal polyps, which is a novel and safe alternative to aspirin challenge, may be recommended to rule out aspirin-exacerbated respiratory disease, prior to the systemic administration of NSAIDs.
在此,我们报告一例年轻男性危及生命的哮喘持续状态,该患者有鼻息肉,但无过敏反应或哮喘病史。
患者术前呼吸系统检查结果正常。术后哮喘在输注非甾体抗炎药(NSAIDs)后发作,病情严重且难以控制。提示NSAIDs输注与哮喘发作之间存在关联。氟比洛芬酯,一种非选择性COX2抑制剂,很可能是该病例的致病因素,尽管此前尚无该药物引发哮喘的报道。
我们得出结论,在该病例中氟比洛芬酯诱发了严重的支气管痉挛。对氟比洛芬酯敏感的患者通常会对其他NSAIDs产生反应;因此,超敏患者应谨慎使用其他普通NSAIDs。对于有鼻息肉的个体,鼻内给予酮咯酸激发试验可能是一种新颖且安全的替代阿司匹林激发试验的方法,在全身使用NSAIDs之前,推荐用于排除阿司匹林加重的呼吸系统疾病。