Diagnostic value of lysine-aspirin bronchoprovocation test for aspirin-sensitive asthma

Abstract

Aspirin(ASA) and NSAIDs can induce bronchoconstriction in 10∼20% of adult

asthmatics patients. Inhalation of lysine-ASA(L-ASA) has been described as an

alternative method for diagnosis of ASA-sensitive asthma. To further understand the

characterlstics of ASA-sensitive asthmas. we studied 38 asthmatic patients with ASA

-sensitivity (36 intrinsic and 2 extrinsic asthma) proven by L-ASA bronchoprovocation

test (BPT).

Most were female (male to female ratio was 27:73). Twenty (53%) of them had no

previous history of adverse reactions when exposed to ASA. Twenty nine (79%) had

rhino-sinusitis symptoms. Early asthmatic response was observed in 16 (42%) patients,

late only response in 16(42%), and dual response in 6(16%) patients. The threshold of L-ASA to provoke a positive response ranged from 11.2 to 180 ㎎/㎖ and most (68.3%) had a positive response after the inhalation of 180 ㎎/㎖. Concurrent sensitivity to sulfite was noted in 14 (36%) patients, followed by sensitivity to tartrazine in one (3%) patient.

None showed a positive response to sodium benzoate. After the avoidance from ASA/

NSAIDs with administration of anti-asthmatic medications, symptom and medication

scores reduced in 26(87%) patients among 30 followed patients. They were classified

into the improved group: four (13%) patients belonged to the not-improved group. There

were no significant differences in clinical characteristics between the improved and not-improved group (p>0.05).

In conclusion, L-ASA BPT could be considered as a useful method to diagnose ASA

-sensitive asthma and be used to screen the causative agent for asthmatic patients with

intrinsic type, especially in female patients with rhino-sinusitis and/or nasal polyp, even though they do not have arty history of adverse reactions. Cessation of exposure and proper treatment may allow to reduce symptom and medication scores.