The Severity of Historical ASA/NSAID-Induced Asthma Attacks Does Not Correlate with Severity of Asthma Induced During Oral ASA Challenges

Abstract

Attacks Does Not Correlate with Severity of Asthma Induced During Oral ASA Challenges A. N. Williams, R. A. Simon, K. M. Woessner, D. D. Stevenson; Scripps Clinic, San Diego, CA. RATIONALE: Historical aspirin (ASA) or nonsteroidal antiinflammatory drug (NSAID)-induced reactions might provide predictive information about the severity of reactions in patients with aspirin exacerbated respiratory disease (AERD) undergoing oral ASA challenges (OAC). METHODS: The provoking doses, treatments, and treatment settings of the historical ASA/NSAID-induced asthma attacks was obtained from 210 consecutive patients with suspected AERD referred for OAC and ASA desensitization. RESULTS: Of 210 subjects, 147 (70%) reported seeking acute medical care for their historical ASA/NSAID-induced asthma attacks. Of these 147, 101 (69%) were treated in ERs and released and 46 (31%) required hospitalization. During OAC in these 147 subjects, 37 (25%) had a >20% decline and 14 (10%) had a >30% decline in FEV1 values. Of the 46 patients previously hospitalized for ASA/NSAID-induced asthma attacks, 15 (33%) had a >20% decline and 6 (13%) had a >30% decline in FEV1 during OAC. By contrast, of the 63 patients who treated their prior ASA/NSAID-induced reactions at home, 10 (16%) had a >20% decline and 5 (8%) had a >30% decline in FEV1 during OAC (p value NS for both). The average provoking doses of ASA were 550 mg for the historical reaction and 62 mg during OAC. CONCLUSIONS: The severity of the historical ASA/NSAID-induced asthma attack was not helpful in predicting asthma severity during OAC. Even though 70% of patients sought acute medical care for asthma attacks provoked by therapeutic doses of ASA/NSAID, a minority had clinically significant asthma during low-dose OAC. These data provide further reassurance regarding the safety of outpatient ASA desensitization. Funding: General Clinical Research Center, Scripps Clinic