Morwood K, Gillis D, Smith W, Kette F
Queensland Health Pathology Service, Princess Alexandra Hospital Campus, Brisbane, Queensland 4102, Australia.
Intern Med J. 2005 Apr;35(4):240-6. doi: 10.1111/j.1445-5994.2004.00801.x.
Aspirin-sensitive asthma is a common and often underdiagnosed disease affecting up to 20% of the adult asthmatic population. It is associated with more severe asthma, requires increased use of inhaled and oral corticosteroids, more presentations to hospital and a risk of life-threatening reactions with aspirin/non-steroid anti-inflammatory drug (NSAID) ingestion. Aspirin-sensitive asthma is often accompanied by severe rhinosinusitis and recurrent nasal polyposis, causing significant impairment of patients' quality of life. The pathogenesis of aspirin-sensitive asthma is complex and involves chronic eosinophilic inflammatory changes, with evidence of increased mast cell activation. The cyclo-oxygenase pathways play a major role in the respiratory reactions that develop after aspirin ingestion. The cysteinyl-leukotrienes have also been shown to play a role in the pathogenesis of aspirin-sensitive asthma. The clinical management of aspirin-sensitive asthma is complicated by the lack of diagnostic testing, other than challenge procedures. Other aspects of management include management of the underlying asthma and avoidance of NSAID in the majority of patients. Other considerations in the management of patients with aspirin-sensitive asthma include the role of leukotriene modifying agents, aspirin desensitization, and the use of other agents, such as roxithromycin. The management of nasal polyposis in patients with aspirin-sensitive asthma often needs to be considered as a separate issue, and requires a team approach.
阿司匹林敏感性哮喘是一种常见且常被漏诊的疾病，影响着高达20%的成年哮喘患者群体。它与更严重的哮喘相关，需要增加吸入和口服糖皮质激素的使用，更多次前往医院就诊，并且存在因摄入阿司匹林/非甾体抗炎药（NSAID）而出现危及生命反应的风险。阿司匹林敏感性哮喘常伴有严重的鼻窦炎和复发性鼻息肉，对患者的生活质量造成显著损害。阿司匹林敏感性哮喘的发病机制复杂，涉及慢性嗜酸性粒细胞炎症变化，有肥大细胞活化增加的证据。环氧化酶途径在摄入阿司匹林后发生的呼吸反应中起主要作用。半胱氨酰白三烯也已被证明在阿司匹林敏感性哮喘的发病机制中起作用。除激发试验外，缺乏诊断检测使得阿司匹林敏感性哮喘的临床管理变得复杂。管理的其他方面包括对基础哮喘的管理以及在大多数患者中避免使用NSAID。阿司匹林敏感性哮喘患者管理中的其他考虑因素包括白三烯调节剂的作用、阿司匹林脱敏以及使用其他药物，如罗红霉素。阿司匹林敏感性哮喘患者鼻息肉的管理通常需要作为一个单独的问题来考虑，并且需要团队协作的方法。
