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KMID : 1225720100020010048
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Allergy, Asthma & Immunology Research : AAIR
2010 Volume.2 No. 1 p.48 ~ p.54
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Protection of leukotriene receptor antagonist against aspirin-induced bronchospasm in asthmatics
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Park Jong-Sook
Jang An-Soo
Park Sung-Woo
Lee Young-Mok
Uh Soo-Taek
Kim Yong-Hoon
Cha Ji-Yean
Park Se-Min
Park Choon-Sik
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Abstract
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Purpose: Leukotriene receptor antagonists (LTRAs) are used to treat aspirin-intolerant asthma (AIA); however, the protective effects of long-term LTRA administration against aspirin-induced bronchospasm have not been evaluated.
Objectives: We investigated the efficacy of a 12-week treatment with a LTRA in protecting against aspirin-induced asthma in AIA patients.
Methods: Fifty-two adult patients with AIA underwent an aspirin challenge test just before administration of montelukast (10 mg/day) and just after 12 weeks of treatment. The protective effect was assessed as the disappearance of aspirin-induced bronchospasm after 12 weeks of treatment. The results were compared according to the patients’ clinical and physiological parameters.
Results: The decline in FEV1 following aspirin challenge was significantly reduced from 28.6±1.9% to 10.2±1.7% (P=0.0001) after 12 weeks of montelukast treatment. However, 14 subjects (30%) still showed a positive response (>15% decline in FEV1) to aspirin challenge. Grouping the subjects into good and poor responders according to post-treatment responses revealed that the pretreatment aspirin-induced FEV1 decline was significantly greater in the poor responders and that the triggering dose of aspirin and the induction time for a positive response were lower and shorter, respectively, in the poor responders. Histories of aspirin hypersensitivity and sinusitis were more prevalent among the poor responders than among the good responders.
Conclusions: Twelve weeks of treatment with montelukast protected against aspirin-induced bronchospasm in 70% of the AIA cases. A poor response was associated with more severe aspirin-induced bronchospasms before treatment and a history of aspirin hypersensitivity or sinusitis.
Clinical implications : A severe response to aspirin challenge may be a predictor of poor responsiveness to leukotriene antagonist treatment.
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KEYWORD
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Asthma, leukotriene antagonists, aspirin, eosinophils
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