Comparison of bronchial and per oral provocation with aspirin in aspirin-sensitive asthmatics

Oral challenge with acetylsalicylic acid was compared with inhalation of Lysine acetylsalicylic acid (L-ASA) as a means to diagnose aspirin-idiosyncrasy in the airways. On the basis of history and/or clinical findings (asthma, rhinorrhea, nasal polyposis) 22 consecutive patients were challenged by both routes. Ten of these developed significant bronchoconstriction (greater than or equal to 20% drop in forced expiratory volume in one second (FEV1)) during either challenge, with the same absolute sensitivity for both tests (9/10). During the bronchial provocations, the reactions developed more promptly (20 min vs 1 h after provocation dose) and were limited to the airways. In contrast, the reactions evoked by the oral provocations were often more pronounced, longer lasting and occurrence of generalized symptoms was more common. Accordingly, the oral tests required more extensive drug treatment for reversal, whereas the bronchial provocations always were reversed by inhalation of bronchodilators. The bronchial method thus resulted in considerably shorter test sessions (4 h vs 8 h). The specificity of the bronchial test was indicated by the observation that a control group of 19 asthmatics with comparable severity of disease failed to bronchoconstrict in response to L-ASA. In conclusion, we have found the bronchial provocation method to be easy to interpret and to control, even in severely asthmatic patients. Consequently, bronchial provocation with L-ASA appears particularly useful in the out-patient office or for research on airway responses to ASA in ASA-sensitive asthmatics.