Korean J Intern Med.  2010 Sep;25(3):309-316. 10.3904/kjim.2010.25.3.309.

Airway Responsiveness to Inhaled Aspirin is Influenced by Airway Hyperresponsiveness in Asthmatic Patients

• Kim S
• Choi IS
• Kim YJ
• Kim CS
• Han ER
• Park DJ
• Kim DE

• KMID: 1776613
• DOI: http://doi.org/10.3904/kjim.2010.25.3.309

Abstract

BACKGROUND/AIMS
Many patients with aspirin-induced asthma have severe methacholine airway hyperresponsiveness (AHR), suggesting a relationship between aspirin and methacholine in airway response. This study was performed to determine whether methacholine AHR affects the response of asthmatics to inhaled aspirin.
METHODS
The clinical records of 207 asthmatic patients who underwent inhalation challenges with both aspirin and methacholine were reviewed retrospectively. An oral aspirin challenge was performed in patients with a negative inhalation response. The bronchial reactivity index (BRindex) was calculated from the percent decrease in lung function divided by the last dose of the stimulus.
RESULTS
Forty-one (20.9%) and 14 (7.1%) patients showed a positive response to aspirin following an inhalation and oral challenge, respectively. Only 24.3 and 14.3% of the responders had a history of aspirin intolerance, respectively. The methacholine BRindex was significantly higher in the inhalation responders (1.46 +/- 0.02) than in the oral responders (1.36 +/- 0.03, p < 0.01) and in non-responders (n = 141, 1.37 +/- 0.01, p < 0.001). The aspirin BRindex was significantly correlated with the methacholine BRindex (r = 0.270, p < 0.001). Three of four patients who received the oral challenge, despite a positive inhalation test, showed negative responses to the oral challenge. Two of these patients had severe AHR.
CONCLUSIONS
A considerable number of asthmatic patients with no history of aspirin intolerance responded to the inhalation aspirin challenge. The airway response to aspirin was significantly correlated with methacholine-AHR, and a false-positive response to aspirin inhalation test seemed to occur primarily in patients with severe AHR.

Keyword

Asthma, aspirin-induced; Methacholine; Bronchial reactivity

MeSH Terms

Administration, Inhalation
Adolescent
Adult
Aspirin/*administration & dosage/*adverse effects
Asthma/*physiopathology
Asthma, Aspirin-Induced/etiology/physiopathology
Bronchial Hyperreactivity/physiopathology
Bronchial Provocation Tests
Drug Hypersensitivity/etiology/physiopathology
Female
Humans
Male
Methacholine Chloride/*administration & dosage
Retrospective Studies
Young Adult