If inflammation is the primary problem in asthma, why can’t oral anti-inflammatories, such as naproxen or ibuprofen, be used for treatment?
—Anthony Cabrera, MD, Loveland, Colo.

Inflammation plays a central role in body homeostasis and response to injury. Multiple, overlapping, complex, and, in some cases, poorly understood pathways modulate the inflammatory process. Among the inflammatory cascade pathways, the 5-lipoxygenase pathway that converts arachidonic acid to leukotrienes plays a significant role in asthma. The inhibition of this pathway is the basis for corticosteroid therapy and for leukotriene inhibitor therapy of asthma (montelukast, zafirlukast, and zileuton). Aspirin and nonsteroidal anti-inflammatory drugs (which primarily exert their anti-inflammatory effects through modulation of cyclooxygenase [COX] enzymes) actually have the potential to provoke bronchospasm and anaphylaxis, especially in patients with the clinical triad of asthma, nasal polyps, and aspirin sensitivity (so-called triad asthma).
—R. Steven Tharratt, MD, MPVM