Study on diagnosis of Aspirin-induced asthma using BDORT

A preliminary report

 Heiichi Yano M.D., Ph.D.¹⁾, Satoshi Ayuzawa M.D., Ph.D.²⁾ ,

1) Internal Medicine, Kashiwa Hospital, Jikei University School of Medicine, Chiba, Japan.

2) Dept. of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan.

 【Purpose】Aspirin-induced asthma(AIA) is a clinical syndrome characterized by acute airway reactions to nonsteroidal anti-inflammatory drugs(NSAID), such as aspirin, with anti-cyclooxygenase activity. It accounts for about 10% of adult asthma and is also known as its severe, life-threatening asthmatic attacks. In most cases, AIA patients were diagnosed after the first asthma attacks induced by NSAIDs, which were prescribed without much consideration. AIA is identified by aspirin challenge test, but it cannot be performed as a routine clinical test because of its risk and complexity.  The aim of this study is to clarify the diagnostic value of Bi-Digital O-Ring Test (BDORT) for AIA.

【Subjects】Twelve asthma patients who had history of NSAID use were enrolled.  Nine patients who had been apparently induced asthmatic attacks (AIA), and three had not been induced (non AIA).

【Methods】We estimated the responses to NSAIDs on their nose , Tien Tu, Zong Fu and the representing area of thymus using BDORT with indirect method.  We examined 21 kinds of acid NSAIDs with anti-cyclooxygenase activity including salicylates, pyrazolones, aryl acetates, propionates, fenamic acid and oxicam, and 3 kinds of basic NSAIDs including tiaramide hydrochloride, tinoridine hydrochloride and emorfazone.  We also examined two kinds of aniline, acetaminophen and phenacetin.  With regard to the dose of NSAIDs, we examined from equal to tripled ordinary dosage.

【Results】All AIA patients showed abnormal responses to the acid NSAIDs and phenacetin, while they didn't show any abnormal responses to the basic NSAIDs and acetaminophen.  Among these acid NSAIDs, the abnormal response to mefenamic acid was relatively mild. The abnormal responses appeared with smaller dosage on the representing area of thymus than on the other areas.  All non-AIA patients didn't show any abnormal responses to all tested NSAIDs, even if in tripled dosage.

【Discussion】 The results obtained in this study indicate the possibility to avoid severe attacks induced by NSAIDs using BDORT. BDORT may be a useful diagnostic method of AIA. Further study is necessary for asthma patients whose responses to NSAIDs are not previously known by their history.

 Address correspondence to: 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567,Japan.