Intranasal challenge with aspirin in the diagnosis of aspirin intolerant asthma: evaluation of nasal response by acoustic rhinometry
- aServei de Pneumologia Hospital General, Vic, Spain, bUnitat d′Epidemiologia i Bioestadistica, Institut d'Investigacions Bimédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, cInstitut d' Investigacions Bimédiques August Pi i Sunyer (IDIBAPS) Barcelona, Spain, dServei de Otorrinolaringologia, Hospital Clinic, Barcelona, Spain, eServei de Pneumologia, Institut Clinic de Pneumologia i Cirurgia Toràcica, Hospital Clinic, Departament de Medicina, Facultat de Medicina, Barcelona, Spain
- Dr C Picado, Institut de Pneumologia, Villarroel 170, Hospital Clinic, 08036 Barcelona, Spain
- Received 9 March 2000
- Revision requested 23 June 2000
- Revised 19 July 2000
- Accepted 8 August 2000
BACKGROUND Nasal provocation tests with lysine-aspirin have recently been introduced for assessment of aspirin intolerant asthma. A study was undertaken to evaluate the usefulness of acoustic rhinometry, a new non-invasive technique, in the diagnosis of aspirin intolerant asthma/rhinitis.
METHODS Fifteen patients with aspirin intolerant asthma/rhinitis (nine women, mean (SD) age 54.7 (14) years), eight patients with aspirin tolerant asthma/rhinitis (three women, mean (SD) age 52.6 (7.8) years), and eight healthy subjects (two women, mean (SD) age 32.5 (9.7) years) were studied. All subjects were challenged with saline (0.9% NaCl) and 25 mg lysine acetylsalicylic acid (L-ASA) instilled into each nostril of the nose on two separate days. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. Symptoms and rhinometry curves were recorded at 10 minute intervals for three hours, one hour before challenge and two hours after challenge.
RESULTS L-ASA challenge induced a significant increase in symptoms in patients with aspirin intolerant asthma/rhinitis. No differences in the clinical response were detected in those with aspirin tolerant asthma/rhinitis or healthy subjects. L-ASA challenge induced a significant decrease in nasal volume measured by acoustic rhinometry in aspirin intolerant patients. No differences were detected between the challenges in aspirin tolerant patients. If a 25% decrease in nasal volume is taken as the cut off point, the specificity of the test was 94% and the sensitivity reached 73%. The nasal challenge was well tolerated by all subjects.
CONCLUSION Acoustic rhinometry may be used to study the nasal response to L-ASA. Nasal challenge with L-ASA is safe and can be used as a diagnostic test even in asthmatic patients with severe bronchial obstruction.