title: Extrabronchial symptoms and late phase reaction enhance the diagnostic value of aspirin bronchial challenge.
abstract: BACKGROUND
  Lysine aspirin (l-ASA) bronchial challenge can be used in the diagnostics of aspirin exacerbated respiratory disease. It is safer than oral challenge, however it is characterized by a lower sensitivity.
  
  
  OBJECTIVE
  We sought to investigate whether additional indicators of the positive result of l-ASA bronchial challenge, i.e. late phase reaction (LPR) and extrabronchial symptoms (EBS), may enhance its diagnostic value.
  
  
  METHODS
  Sixty-seven patients with a positive history of asthma exacerbated by aspirin and/or other non-steroidal inflammatory drugs underwent l-ASA bronchial challenge. The control groups comprised 15 aspirin tolerant asthmatics and 15 healthy subjects. Forced expiratory volume in 1 s (FEV1) and 24-hour peak expiratory flow (PEF) measurements were performed in all subjects in order to recognize early and late response to l-ASA. All subjects underwent oral ASA challenge 2 weeks after l-ASA bronchial challenge.
  
  
  RESULTS
  Basing on FEV1 and PEF results, early reaction was present in 50.7% of patients, early and LPR in 29.9% and LPR in only 10.4% of aspirin exacerbated respiratory disease patients. The EBS were noted in 31.3% of subjects. Inclusion of LPR and EBS as positive criteria of the challenge increased sensitivity to 94.0%.
  
  
  CONCLUSIONS
  These results indicate that both LPR and EBS should be considered as positive criteria of aspirin bronchial challenge as they enhance its diagnostic value.
authors.affiliation: Department of Internal Diseases, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland. Head of the Department: Prof. Piotr Kuna MD, PhD.
authors.forename: Damian
authors.initials: D
authors.lastname: Tworek
authors.affiliation: Department of Pneumonology and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland. Head of the Department: Prof. Paweł Górski MD, PhD.
authors.forename: Ewa
authors.initials: E
authors.lastname: Zielińska-Wyderkiewicz
authors.affiliation: Department of Pneumonology and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland. Head of the Department: Prof. Paweł Górski MD, PhD.
authors.forename: Paweł
authors.initials: P
authors.lastname: Górski
authors.affiliation: Department of Internal Diseases, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland. Head of the Department: Prof. Piotr Kuna MD, PhD.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kuna
keywords: aspirin; extrabronchial symptoms; late phase reaction