Non-steroid anti-inflammatory drugs in asthma: dangerous or useful therapy?

The therapeutic potential of non-steroid anti-inflammatory drugs in clinical asthma is offset by the real possibility of hypersensitivity and induction of severe airways obstruction. The influence of indomethacin on the antigen-induced asthmatic response was tested. Early and delayed asthmatic responses were recorded after antigen challenge in 13 subjects. Indomethacin pretreatment totally or partially inhibited the delayed asthmatic response in 10 of 11 subjects. Inhibition by indomethacin of products of the arachidonic cascade which participate in the pathogenesis of the delayed asthmatic response could explain this phenomenon. A similar therapeutic response was documented without adverse drug reactions when five subjects were restudied after several months. In the same group the early asthmatic response was suppressed in six, enhanced in two and unchanged in four of 12-subjects. This variable response indicates that spasmogenic prostaglandin breakdown products may be important for certain individuals, but are generally of less importance in the early asthmatic response. Clinical trials with indomethacin as a steroid saving agent in allergic asthma appear feasible and can be conducted safely.