Article first published online: 6 APR 2005
Internal Medicine Journal
Volume 35, Issue 4, pages 240–246, April 2005
How to Cite
Morwood, K., Gillis, D., Smith, W. and Kette, F. (2005), Aspirin-sensitive asthma. Internal Medicine Journal, 35: 240–246. doi: 10.1111/j.1445-5994.2004.00801.x
Potential conflicts of interest: There are no potential conflicts or funding for the work to declare on hehalf of any of the authors.
- Issue published online: 6 APR 2005
- Article first published online: 6 APR 2005
- Received 12 January 2004;accepted 15 October 2004.
- nasal polyposis;
- Samter’s triad;
- aspirin desensitization
Aspirin-sensitive asthma is a common and often underdiagnosed disease affecting up to 20% of the adult asthmatic population. It is associated with more severe asthma, requires increased use of inhaled and oral corticosteroids, more presentations to hospital and a risk of life-threatening reactions with aspirin/non-steroid anti-inflammatory drug (NSAID) ingestion. Aspirin-sensitive asthma is often accompanied by severe rhinosinusitis and recurrent nasal polyposis, causing significant impairment of patients’ quality of life. The pathogenesis of aspirin-sensitive asthma is complex and involves chronic eosinophilic inflammatory changes, with evidence of increased mast cell activation. The cyclo-oxygenase pathways play a major role in the respiratory reactions that develop after aspirin ingestion. The cysteinyl-leukotrienes have also been shown to play a role in the pathogenesis of aspirin-sensitive asthma. The clinical management of aspirin-sensitive asthma is complicated by the lack of diagnostic testing, other than challenge procedures. Other aspects of management include management of the underlying asthma and avoidance of NSAID in the majority of patients. Other considerations in the management of patients with aspirin-sensitive asthma include the role of leukotriene modifying agents, aspirin desensitization, and the use of other agents, such as roxithromycin. The management of nasal polyposis in patients with aspirin-sensitive asthma often needs to be considered as a separate issue, and requires a team approach. (Intern Med J 2005; 35: 240–246)