Aspirinin artırdığı solunumsal hastalık (Aspirin duyarlı astım, Aspirin ile indüklenen astım, Samter triadı)

Abstract

Aspirin-exacerbated respiratory disease (AERD) is an aggressive and progressive inflammatory airway disease characterised with attacks of asthma and rhinitis after ingestion of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin hypersensitivity is present in 13.6% of asthmatic patients in Turkey. AERD should be considered especially in cases with a history of dyspnea or asthma attack related to ingestion of aspirin or NSAIDs, chronic and intractable nasal congestion, rinorrhea together with abscence of atopy, nasal poliposis, pansinusitis and severe asthma attacks, without a specific triggering factor, which requires hospitalization in intensive care unit. Diagnosis of AERD is based on aspirin provocation test. Aspirin desensitization is suggested in AERD patients with intractable symptoms despite medical treatment, recurrent nasal polyps requiring multiple surgeries, nasal symptoms and/or asthma requiring frequent systemic corticosteroid use and in case of additional medical indication for aspirin. Aspirin desesnsitization is a clinically- and cost-effective treatment method.

Keywords

• Aspirin
• asthma
• desensitization

ASPİRİNİN ARTIRDIĞI SOLUNUMSAL HASTALIK (ASPİRİN DUYARLI ASTIM, ASPİRİN İLE İNDÜKLENEN ASTIM, SAMTER TRİADI)

Abstract

Aspirinin artırdığı solunumsal hastalık (AASH) aspirin veya çoğu nonsteroidal antiinflamatuvar ilaçların (NSAII) alımından sonra görülen astım alevlenmeleri ve rinit atakları ile karakterize agresif ve süreğen inflamatuvar hava yolu hastalığıdır. Türkiye’de astımlı hastaların %13.6’sında aspirin duyarlılığı mevcuttur. Aspirin veya diğer NSAII’lar ile ilişkili dispne veya astım atağı öyküsü, kronik ve inatçı nazal konjesyon veya özellikle allerji cilt testlerinin negatifliğinde rinore, nazal polipozis, pansinüzit ve belirgin bir sebep olmaksızın yoğun bakım takibi gerektiren ağır astım atakları ile başvuran olgularda tanıda şüphelenilmelidir. AASH tanısının kesinleştirilmesi aspirin provokasyon testi ile mümkündür. Medikal tedaviye rağmen inatçı semptomları olan, multipl cerrahi gerektiren tekrarlayan nazal poliplerin ya da astım ve /veya nazal semptomları kontrol etmek için sık sistemik kortikosteroid ihtiyacı olan veya aspirin endikasyonu olan ek medikal durum varlığında AASH’lı hastalarda aspirin desensitizasyonu yapılabilir. Aspirin desensitizasyon tedavisinin klinik ve maliyet olarak etkin bir tedavi yöntemi olduğu gösterilmiştir.

Keywords

• Aspirin
• asthma
• desensitization

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