The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Airway Responsiveness to Inhaled Aspirin is Influenced by Airway Hyperresponsiveness in Asthmatic Patients

  • Kim, Sung-Soo (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Choi, In-Seon S. (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Kim, Yeon-Joo (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Kim, Chang-Seong (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Han, Eui-Ryoung (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Park, Dong-Jin (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences) ;
  • Kim, Dae-Eun (Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences)
  • Received : 2010.01.20
  • Accepted : 2010.04.07
  • Published : 2010.09.01
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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 $(1.46{\pm}0.02)$ than in the oral responders ($1.36{\pm}0.03$, p < 0.01) and in non-responders (n = 141, $1.37{\pm}0.01$, 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.

Keywords

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