SESSION TITLE: Diffuse Lung Disease Student/Resident Case Report Posters
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Selective Cox 2 inhibitors have always been considered safe in asthma patients, and there have been studies elucidating the same. But in selected sensitive individuals, they can cause exacerbation of their asthma symptoms.
CASE PRESENTATION: 45-y.o. female with history of bronchial asthma was seen at the clinic for asthma exacerbation. PMH: GERD, seronegative arthritis, overactive bladder Medications: Advair, celebrex, singulair. O/E: vitals stable, bilateral wheeze.Patient was started on IV steroids, and Duo-neb, improved symptomatically. On further evaluation of her history, she had had well controlled asthma until a year ago. She used to use her albuterol inhaler less once a month, but in the past year, she has been using it few times every day, and more than 2 nights a week. She has also had frequent exacerbations during this period.Sshe also felt relief after starting singulair. Apparently she was started on celecoxib, a selective Cox 2 inhibitor, a year ago, for seronegative arthritis. Also, her exacerbations during the past year correlated with the times she had taken increased doses of celecoxib for an arthritis flare. Her celecoxib was discontinued. She was discharged home and she was to follow up with rheumatology for alternate treatments for arthritis. She was started on plaquenil, and has been off celecoxib, for 6 months. Her asthma is better controlled, she has not had an exacerbation.
DISCUSSION: Discussion Although there have been reports demonstrating safety of Cox 2 inhibitors in patients with asthma, there has also been a question of exacerbation of aspirin induced asthma by Cox2 inhibitors. In a large retrospective study, cross reactivity of acetaminophen and celecoxib in patients with NSAID hypersensitivity , the latter was found to be 10% . In one of few case reports, celecoxib was found to exacerbate aspirin induced asthma. This was confirmed by oral challenge test with 100 mg of celecoxib. Etoricoxib, also has been shown to cause asthma exacerbations in aspirin sensitive individuals . It has been shown that treatment with Leukotriene receptor antagonists inhibit asthma attacks induced by celecoxib . This could explain the response of our patient to montelukast. Our patient’s aspirin sensitivity is not known, and she was recommended to avoid the same in the future too. Ideally she would require an allergy test to prove both sensitivities.
CONCLUSIONS: Although celecoxib has been shown to be safe in patients with asthma, it does cause exacerbation in selected sensitive individuals, and this has to be in consideration when patients on celcoxib present with frequent asthma exacerbations.
Reference #1: 1. Kim, Yoon-Jeong, et al. “Cross-Reactivity to Acetaminophen and Celecoxib According to the Type of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity.” Allergy, Asthma & Immunology Research 6, no. 2 (March 2014): 156-62. doi:10.4168/aair.2014.6.2.156.
DISCLOSURE: The following authors have nothing to disclose: Charumathi Raghu Subramanian, Asad Shafiq, Sean Devine
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