title: Airway responsiveness to inhaled aspirin is influenced by airway hyperresponsiveness in asthmatic patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Allergy, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Kim
authors.forename: Inseon S
authors.initials: IS
authors.lastname: Choi
authors.forename: Yeon-Joo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Chang-Seong
authors.initials: CS
authors.lastname: Kim
authors.forename: Eui-Ryoung
authors.initials: ER
authors.lastname: Han
authors.forename: Dong-Jin
authors.initials: DJ
authors.lastname: Park
authors.forename: Dae-Eun
authors.initials: DE
authors.lastname: Kim
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D001249:Asthma / Q000503:physiopathology*; D055963:Asthma, Aspirin-Induced / Q000209:etiology / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D004342:Drug Hypersensitivity / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride / Q000008:administration & dosage*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D016210:Methacholine Chloride; D001241:Aspirin