Sanja Baldzieva, Gordana Panova, Anica Baldzieva
Faculty of Medicine University of Shtip, Asthma Center, General Hospital, Strumica, Macedonia
respiratory disease, asthma, aspirin-induced asthma
''8. Međunarodni kongres HDMSARIST-a''
Šibenik, 23.-26. travnja 2015. godine
Introduction:The term AIA-exacerbated respiratory disease is the best description of the
aggressive and continuous inflammatory disease of the airways, combined with exacerbation
of asthma and rhinitis attacks, after ingestion of ASA and most nonsteroidal anti-inflammatory
drugs (NSAIDs).
Purpose: Asthma is a chronic inflammatory disease of the airways that often starts in
childhood, although there are data that sometimes itself may disappear, and many of the
patients that have whole life. In most patients, symptoms of rhinitis first occur during the third
decade, often after a viral respiratory illness. Over a period of months, chronic nasal
congestion, anosmia, and rhinorrhoea develop. Physical examination often reveals nasal
polyps. Bronchial asthma and sensitivity to aspirin develops next. After ingestion of aspirin or
an NSAID, an acute asthma attack occurs within a few minutes up to three hours, usually
accompanied by profuse rhinorrhoea, conjunctival infection, periorbital oedema, and
sometimes a scarlet flushing of the head and neck Rarely, in patients who produce extremely
high amounts of Cys-LT, myocardial ischemia may develop.
Materials and methods:Retrospectively are considered data for a period of 3 years and 3
months (May, 2008 - August 2011) of the Asthma Center which covers the region of Strumica
municipality with 25 villages. In that period are reported 273 cases of asthma in patients aged
15 to 86 years. Of those reported cases of asthma in the reviewed period, 3 cases were
diagnosed as aspirin-induced asthma.
Results and discussion: The results show that 1.09% of people suffering from asthma in the
reviewed period have aspirin-induced asthma.Studies of aspirin induced asthma in different
populations have found prevalences ranging from 1% to 20%, with the differences being
attributed either to the methods of diagnosis or differences in the populations being
assessed.Based on patients’ histories alone, the incidence of ASA sensitivity in asthmatic
adults is 3% to 5%, but this percentage rises to 19% when adult asthmatic patients are
prospectively challenged with ASA. Even in asmatics without a history of aspirin intolerance,
9% show sensitivity to oral challenging with aspirin and in patients with rhinosinusitis
prevalence grows up to 34%.Estimates of the prevalence of aspirin induced asthma depend
on the methods used, however. It has been suggested that the gold standard for diagnosing
aspirin induced asthma should be either oral or inhaled challenge with aspirin. Challenge
studies have suggested prevalences as high as 20%( results similar to above mentioned
19%) in some populations and it is possible that many patients are diagnosed who did not
realise that aspirin made their asthma worse.
Conclusion:Increased production of leukotriene LTC4 and decreased production of
prostaglandin PGE2 promote clinical picture of the AIA in asthmatics after ingestion of aspirin.
The prevalence in the region covered by the investigation, compared with the prevalence
worldwide is much smaller. Lack of pre-test diagnosis, beyond recognition of mild forms of
aspirin sensitivity as AIA, not sufficiently informed patients are part of the reasons
contributing to this percentage is lower than the real situation.