The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Pages 970-975, November 2005

Aspirin sensitivity and severity of asthma: Evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma

  • Kimberly Mascia, MD

      Affiliations

    • From the University of Virginia Health Systems, Charlottesville
    • ,
  • Tmirah Haselkorn, PhD

      Affiliations

    • Genentech, Inc, South San Francisco
    • ,
  • Yamo M. Deniz, MD

      Affiliations

    • Genentech, Inc, South San Francisco
    • ,
  • Dave P. Miller, MS

      Affiliations

    • Ovation Research Group, San Francisco
    • ,
  • Eugene R. Bleecker, MD

      Affiliations

    • Wake Forest University, Winston-Salem
    • ,
  • Larry Borish, MD

      Affiliations

    • From the University of Virginia Health Systems, Charlottesville
    • Corresponding Author InformationReprint requests: Larry Borish, MD, Asthma and Allergic Disease Center, Box 801355, University of Virginia Health Systems, Box 801355, Charlottesville, VA 22908-1355.
    • ,
  • for the TENOR Study Group

      Affiliations

    • For a complete list of TENOR Study Group members, please contact Genentech, Inc.

Received 19 May 2005; received in revised form 29 July 2005; accepted 2 August 2005. published online 04 October 2005.

Charlottesville, Va, South San Francisco and San Francisco, Calif, and Winston-Salem, NC

Background

Patients with aspirin sensitivity experience hyperplastic sinusitis and nasal polyposis. We speculated that similar mechanisms could be acting in the lower airway and that these individuals would demonstrate more severe asthma and irreversible loss of lung function.

Objective

We sought to investigate the role of aspirin-exacerbated respiratory disease (AERD) as a risk factor for the development of irreversible airway obstruction.

Methods

The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study is a multicenter observational study of subjects with severe or difficult-to-treat asthma. Data were compared between subjects who reported asthma exacerbation after aspirin ingestion and those who did not. The primary measure of bronchodilator-resistant obstruction (possible remodeling) was the maximally achieved postbronchodilator spirometry averaged over the 3-year duration of the study.

Results

Adult subjects (≥18 years) with AERD (n = 459) were compared with subjects with non–aspirin-sensitive asthma (n = 2848). Subjects with AERD had significantly lower mean postbronchodilator percent predicted FEV1 compared with subjects with non–aspirin-sensitive asthma (75.3% vs 79.9%, P < .001). Differences in spirometry between the 2 cohorts persisted after controlling for potential confounding variables. In addition, subjects with AERD were more likely to have severe asthma by means of physician assessment (66% vs 49%, P < .001), to have been intubated (20% vs 11%, P < .001), to have a steroid burst in the previous 3 months (56% vs 46%, P < .001), and to have required high-dose inhaled corticosteroids (34% vs 26%, P < .001).

Conclusions

These data suggest that aspirin sensitivity is associated with increased asthma severity and possible remodeling of both the upper and lower airways.

Key words: Sinusitis, rhinosinusitis, rhinitis, eosinophils, functional endoscopic sinus surgery

Abbreviations used: AERD, Aspirin-exacerbated respiratory disease, BMI, Body mass index, CHES, Chronic hyperplastic eosinophilic sinusitis, COPD, Chronic obstructive pulmonary disease, FVC, Forced vital capacity, NSAID, Nonsteroidal anti-inflammatory drug, TENOR, The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens

 

 Supported by a grant from Genentech/Novartis and NIH AI50989.Disclosure of potential conflict of interest: T. Haselkorn has consultant arrangements with Genentech and has received grants from Genentech and Novartis Pharmaceuticals Inc. Y. Deniz has received grants from Genentech and Novartis Pharmaceuticals Inc and is employed by Genentech. D. Miller has consultant arrangements with the Ovation Research Group and has received grants from Genentech and Novartis Pharmaceuticals Inc. E. Bleecker has received grants from Genentech and Novartis Pharmaceuticals Inc, is on the speakers' bureau for Genentech and Novartis Pharmaceuticals Inc, and is on the Genentech TENOR Advisory Board. L. Borish is on the TENOR Advisory Board. K. Mascia has no conflicts of interest to disclose.

PII: S0091-6749(05)01924-X

doi:10.1016/j.jaci.2005.08.035

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Pages 970-975, November 2005

Article Tools