Patient 2: A 37-year-old female with reported medical history of asthma was admi
ID: 201209 • Letter: P
Question
Patient 2: A 37-year-old female with reported medical history of asthma was admitted with shortness of breath and thought to be due to asthma attack. She used a budesonide/formoterol inhaler daily, and short-term inhalers for exacerbations a few times per year. She had been hospitalized once prior for asthma but never intubated. The patient was in her usual state of health on the morning of admission when she boarded a flight heading from Hilo toward Togo. She was concerned about developing a blood clot on the long journey, so she took 325mg of aspirin right before take-off. Shortly thereafter, she noticed difficulty breathing, described as trouble getting air in. Symptoms persisted throughout a scheduled stopover in Los Angeles, and the patient became concerned that she would not be able to tolerate the second leg of the flight. She presented to the Emergency Department for further evaluation. She denied chest pain, palpitations dizziness, visual change, audible wheeze, fevers, chills, sick contacts, weight gain, orthopnea paroxysmal nocturnal dyspnea, tobacco use, or IV drug use 0 3. What is causing her current symptoms? Briefly explain the mechanism that triggered the patient's asthma attack. (2p)Explanation / Answer
The symptoms are due to aspirin. The asthma symptoms are exacerbated by a large number of nonsteroidal antiinflammatory drugs. Aspirin is one of the example of such kind of nonsteroidal antiinflammatory drugs. Aspirin blocks the COX1 (cycloxygenase1) which is an enzyme responsible for production of prostaglandins and thromoxane and thus the level of prostaglandins and thromboxane decreases after taking aspirin. The decrease in level of thromoxane and prostaglandins results in the overproduction of pro-inflammatory leukotrienes to causes severe exacerbations of asthma and allergy-like symptoms.