Giuseppe Petrigni

Aspects of bronchial reactivity to prostaglandins and aspirin in asthmatic patients.

The behaviour of bronchial reactivity to PGF2alpha was studied in asthmatic patients under various experimental conditions. Premedication with aminophylline, i.v., and, to a lesser extent, with DSCG afforded a partial protection, while beclomethasone dipropionate was inactive under this point of view. Diftalone, a new non-steroid anti-inflammatory agent, was well tolerated in 9 aspirin-intolerant asthmatic patients, and did not modify the bronchial response to PGF2alpha which was found to be generally lower then that of other aspirin-tolerant asthmatic patients. PGE 1-2 and DSCG prevented the bronchospasm induced by inhalation or ingestion of acetylsalicylic acid in a small group of patients. Good protection was also reached with PGE1-2 in the exercise-induced bronchospasm.

Bronchial Inflammation and NSAIDs

SummaryA wide range of experimental evidence shows that bronchial eosinophilic inflammation plays a major role in the pathogenesis of the asthmatic syndromes characterised by reversible airway obstruction and bronchial hyperresponsiveness. A treatment aimed at controlling inflammation is therefore of primary importance in these pathological conditions. To date, corticosteroids have been routinely used for this purpose, but their administration is often accompanied by serious side effects. Cromoglycate and cromoglycate-like compounds have been proposed as alternative anti-inflammatory agents, but because their anti-inflammatory activity is relatively low, they can replace corticosteroids only in mild asthma. In the most severe forms of asthma, gold salts and methotrexate have demonstrated a steroid-sparing effect, but at the cost of a high incidence of toxic effects.Little attention has been devoted to the use of NSAIDs in asthma for 2 principal reasons. In acute studies, NSAIDs such as aspirin (acetylsalicylic acid) and indomethacin have not shown satisfactory bronchodilator or antireactive activity. More importantly, NSAIDs have traditionally been associated with a relatively high frequency of severe obstructive reactions in patients with asthma.However, nimesulide, a recently developed NSAID, has proven to be safe in NSAID-sensitive patients. Moreover, in guinea-pigs, the drug exhibits good antianaphylactic activity and an impressive antihistaminic effect that is not shared by other NSAIDs such as indomethacin. On the basis of these findings, nimesulide can be considered as a potential antireactive-antiasthmatic agent, of which further clinical investigation is justified.