Breath of Fresh Air: Feature Articles

Chapter 58: Living with Aspirin-Sensitive Asthma

Molly B. has had asthma since early childhood. Part of her childhood treatment for asthma included restricted activities, " I didn't take gym in school and I didn't have a bicycle and I didn't ice skate and roller skate and all those other things," she recalls. "We had no animals and my room was bare and got washed down every day. I slept on a bed that was covered in plastic and had rubber foam pillows and no stuffed animals." Yet she doesn't recall feeling deprived. "They [her parents] made it work out somehow."

Molly has aspirin-sensitive asthma. As a child and adolescent, she took aspirin or ibuprofen without any reaction. Only in the last 10 years did she begin to experience reactions, and they first occured with Tylenol®. "I would flare up — I would have quite a severe asthma attack — almost immediately after taking the Tylenol®, say within 15-20 minutes." She did not immediately connect the medication with her asthma flares. At first she attributed both her headache (for which she took the Tylenol®) and her wheezing to stress. Within an hour or two her asthma would improve.

She didn't become aware of her sensitivity to aspirin until approximately 7 years ago, when she was prescribed ibuprofen (Advil®) for pain relief following dental surgery. She recalls asking both her dentist and her pharmacist whether it was safe for her to take the Advil® and being falsely reassured that it was. She went to her office, took to Advil®, and shortly thereafter was rushed to the hospital with a severe asthmatic attack. "I thought I was going to die. I couldn't breathe at all, and it got progressively worse. It was just awful.

"From that experience, I realized that I was allergic to aspirin and then also realized in retrospect that I had been allergic to the Tylenol®." Now Molly is very cautious about taking any medications that might contain aspirin or related compounds. "I really never take anything over-the-counter and I never add any medication without calling my doctor. Fortunately, I don't get many headaches, and when I do get them they are not very serious and I just put up with them."

Molly’s asthma became quite severe during her adult life. She attributes some of this worsening of her asthma to emotional stresses: the death of her parents, the break-up of her marriage, and working two jobs. She remained on regular prednisone therapy for almost 20 years. With the introduction of the leukotriene modifying drug, zileuton (Zyflo®) two years ago — and with her retirement from a high-pressured job in corporate law — she has been able to get off the oral steroid tablets for nearly 6 months and feels that she is in the best shape ever. She believes that both stress reduction and the new leukotriene modifying medication have had an enormous impact.

This fall she will be able to test which of these two changes has been the key factor in her improvement. She plans to return to work, with all of the anticipated stresses involved in a new law practice. We wish her good luck and good breathing.