Intranasal challenge with aspirin in the diagnosis of aspirinintolerant asthma: evaluation of nasal response by acoustic rhinometry

摘要

BACKGROUND—Nasal provocation tests with lysine-aspirin have recently been introduced for assessment of aspirin intolerant asthma. A study was undertaken to evaluate the usefulness of acoustic rhinometry, a new non-invasive technique, in the diagnosis of aspirin intolerant asthma/rhinitis.
METHODS—Fifteen patients with aspirin intolerant asthma/rhinitis (nine women, mean (SD) age 54.7 (14) years), eight patients with aspirin tolerant asthma/rhinitis (three women, mean (SD) age 52.6(7.8) years), and eight healthy subjects (two women, mean (SD) age 32.5 (9.7) years) were studied. All subjects were challenged with saline (0.9% NaCl) and 25 mg lysine acetylsalicylic acid (L-ASA) instilled into each nostril of the nose on two separate days. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. Symptoms and rhinometry curves were recorded at 10 minute intervals for three hours, one hour before challenge and two hours after challenge.
RESULTS—L-ASA challenge induced a significant increase in symptoms in patients withaspirin intolerant asthma/rhinitis. No differences in the clinicalresponse were detected in those with aspirin tolerant asthma/rhinitisor healthy subjects. L-ASA challenge induced a significant decrease innasal volume measured by acoustic rhinometry in aspirin intolerantpatients. No differences were detected between the challenges inaspirin tolerant patients. If a 25% decrease in nasal volume is takenas the cut off point, the specificity of the test was 94% and thesensitivity reached 73%. The nasal challenge was well tolerated by all subjects.
CONCLUSION—Acousticrhinometry may be used to study the nasal response to L-ASA. Nasalchallenge with L-ASA is safe and can be used as a diagnostic test evenin asthmatic patients with severe bronchial obstruction.