EDITOR—Jenkins et al describe the pooled data for the risk of aspirin induced asthma, and by implication all asthma induced by non-steroidal anti-inflammatory drugs (NSAIDs). 1 NSAIDs are an important group of medicines in the treatment of acute pain after injury. Not all patients are, however, able to tolerate them because of respiratory or gastrointestinal side effects.

It is accepted that more patients are being diagnosed as asthmatic, so is it true that NSAIDs can be prescribed to fewer patients? The trials that were pooled for the meta-analysis had differing selection criteria. It would be fair to comment that the population used for the study is one where the asthma is more severe—asthma clinics and admissions for acute exacerbations. It would be fair to say that most patients with asthma are managed in the community without any problems. To say that anyone under 40 should have a witnessed trial of treatment under supervision or should be prescribed an NSAID only if absolutely necessary will reduce the amount that a useful class of drugs are used. Would this be a valid exclusion from the four hour target the government has set for accident and emergency departments or would doctors therefore have to admit everyone to an observation unit that may not be there merely to prescribe a safe drug?