Asthma Phenotyping and Aspirin Sensitivity

A total of 136 patients with asthma were prospectively enrolled at Ajou University Hospital (Suwon, South Korea). Asthma was diagnosed according to the Global Initiative for Asthma guideline (GINA) 2022 by the allergy specialists.¹ Asthmatics were classified into three groups according to their symptom control status: UA, partly‐controlled asthma (PA), and well‐controlled asthma (CA). Exclusion criteria for enrollment were as follows: (1) asthmatics who had been treated with biologics, including omalizumab, mepolizumab, reslizumab, and dupilumab within 130 days of enrollment; (2) current smokers or ex‐smokers who quit smoking within 30 days of enrollment; and (3) asthmatics whose controller medications were changed within 7 days of enrollment.
AERD was defined by a typical clinical history (recurrent exacerbation of upper or lower respiratory reactions after ingestion of NSAIDs/aspirin) and/or a positive response to the lysine‐aspirin bronchial provocation test (Lys‐ASA BPT). The Lys‐ASA BPT was performed with increasing doses of Lys‐ASA solution up to 300 mg/ml using the method previously reported.¹⁸ The Lys‐ASA BPT result was considered positive if forced expiratory volume in one second (FEV₁)% was decreased by more than 20% after the challenge. ATA was defined when subjects showed negative results to the Lys‐ASA BPT or denied any upper or lower respiratory tract symptom changes after ingestion of NSAIDs/aspirin. Asthma control status was evaluated according to the GINA guideline,¹ asthma control test (ACT), and asthma control questionnaire (ACQ‐6: ACQ mean of six individual item scores).¹⁹ UA was defined when ACT ≤ 19 or ACQ ≥ 1.5.¹ SA was diagnosed according to the definition of international European respiratory society/American thoracic society guidelines.²⁰ Eosinophilic asthma was defined as the PEC ≥ 300/μl.