Natural history of aspirin-induced asthma

There is a subset of patients with bronchial asthma who are susceptible to disease exacerbation upon receiving aspirin and other nonsteroidal anti-inf lammatory drugs. This is a clinical syndrome, called aspirin-induced asthma (AIA), associated with alterations in arachidonate metabolism and cysteiny l-leukotriene overproduction. The natural history and clinical characterist ics of this type of asthma were studied. Sixteen clinical centres in 10 European countries provided standardized inf ormation to the specially developed patient-oriented database regarding: me dical history, physical examination, diagnosis, and treatment. Diagnosis of ATA was based on a typical history, confirmed by positive aspirin provocat ion tests, carried out in 91% of the patients. A total of 500 patients were enrolled in the study. AIA developed according to a pattern, characterized by a sequence of sympto ms. First, persistent rhinitis, appearing at a mean age of 29.7+/-12.5 yrs, then asthma, aspirin intolerance and nasal polyposis appear. The clinical presentation in different European countries was remarkably similar. In fem ales, who outnumbered males by 2.3:1, the onset of symptoms occurred signif icantly earlier and the disease was more progressive and severe than in mal es. Atopy, present in approximately a third of patients, led to earlier man ifestation of rhinitis and asthma, but not of aspirin intolerance or nasal polyposis. A family history of aspirin intolerance, recorded in 6% of patie nts, had a less evident effect on the course of the disease than sex or ato py. Fifty one per cent of patients, in addition to inhaled steroids, requir ed chronic systemic corticosteroid therapy at a mean dose of 8 mg prednison e.day(-1), Surprisingly, 15% of patients were unaware of intolerance to asp irin and learnt about it only after having provocation tests performed. All over Europe, aspirin-induced asthma develops in a similar characteristi c way. Its course is influenced by sex and the presence of atopy. In half o f the patients, asthma is severe, and steroid-dependent. The uniform natura l history of aspirin-induced asthma might suggest a common underlying princ iple.