Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Aspirin desensitization
35%
28/80
Montelukast
38%
30/80
Omalizumab
9%
7/80
Salmeterol
16%
13/80
Theophylline
2%
2/80
Select Answer to see Preferred Response
This patient is presenting with asthma, nasal polyposis, and aspirin exposure, suggestive of aspirin-induced asthma. The best initial treatment is montelukast, an anti-leukotriene. Aspirin-induced asthma is triggered by hypersensitivity to NSAIDs, and it is characteristically accompanied by chronic rhinosinusitis and nasal polyposis (Figure A). There is dysregulation of arachidonic acid metabolism, causing overproduction of leukotrienes that are pro-inflammatory. In addition to the avoidance of NSAIDs, the stepwise approach for asthma management still applies to patients with aspirin-induced asthma. The exception is that leukotriene-modifying agents, such as montelukast or zileuton, are often used to address the underlying increase in leukotriene production. Figure A shows a photograph of a nasal polyp in the right nasal cavity. Incorrect Answers: Answer 1: Aspirin desensitization is indicated in patients for whom nasal polyposis is worsening despite appropriate therapies or in patients who have conditions requiring NSAID therapy (e.g. inflammatory or vascular diseases). Aspirin desensitization would not be the first step in management for this patient. Answer 3: Omalizumab is an anti-IgE therapy that is used when asthma is inadequately controlled on high-dose inhaled glucocorticoids and long-acting beta agonists. Indications for use include evidence of sensitivity to a perennial allergen such as dust mites, pet dander, or mold. Answer 4: Salmeterol is a long acting beta-2 adrenergic agonist used in moderate or severe persistent asthma along with low-doses of an inhaled glucocorticoid. Moderate persistent asthma is characterized by daily symptoms of asthma or nocturnal awakenings more than once a week. Answer 5: Theophylline can be added as part of the "step-up" management of moderate or severe persistent asthma. However, for this patient who has aspirin-induced asthma, a leukotriene-modifying agent would be a more appropriate initial therapy. Bullet Summary: Aspirin-induced asthma can be treated with leukotriene modifying agents due to the underlying overproduction of leukotrienes.
5.0
(13)
Please Login to add comment