By Megan Rauscher
NEW YORK (Reuters Health) – Study results indicate that leukotriene overproduction plays an important role in both allergen-induced asthma and aspirin-intolerant asthma and that pranlukast, a leukotriene receptor antagonist, may be useful in both types of asthma.
Dr. Yasushi Obase, of Helsinki University Central Hospital in Finland, and colleagues in Japan report these findings in the January issue of the journal Chest.
With this study "we wanted to compare the differences of leukotriene's role between atopic and aspirin-induced asthma by using induced sputum," Dr. Obase told Reuters Health.
They subjected six house dust mite-sensitive asthmatics to inhalation provocation tests and seven aspirin-intolerant asthmatics to oral aspirin challenge before and after 7 days of pranlukast treatment.
The allergen-induced asthmatics had both immediate and late asthmatic reactions after provocation tests while the aspirin-intolerant asthmatics displayed only immediate asthmatic reactions to aspirin oral challenge.
In both groups, asthma attacks were accompanied by significant increases in sputum and urinary leukotrienes and sputum eosinophil cationic protein, but the increases were higher in the aspirin-intolerant asthmatics than in the atopic asthmatics.
Allergen-induced asthma "is associated with overproduction of leukotriene with an antigen-antibody reaction, while aspirin-intolerant asthma is associated with overproduction of leukotriene with a shift to the 5-lipoxygenase series of the arachidonate cascade," they report.
Pretreatment with pranlukast in the atopic individuals suppressed the fall in FEV1 to 73.8% during the immediate reaction period and to 51.9% during the late reaction period and inhibited the increase in sputum eosinophils.
In aspirin-intolerant subjects, pranlukast suppressed the immediate asthmatic reaction and inhibited the spike in sputum eosinophils but failed to counter leukotriene production.
"Nowadays it has become a topic that asthma is regarded as a systemic disease. We don't deny this point of view, but our study suggests that we should listen to the message from the 'local' organ carefully as well," Dr. Obase told Reuters Health.
He emphasized that further investigation is still needed, but it does appear that "leukotriene receptor antagonists suppress the aspirin-induced asthma attack to a certain level."
Chest 2002;121:143-150.
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