Asthma is characterized by changes in eicosanoids metabolism, especially high production of
bronchoconstrictive cysteinyl leukotrienes (CystLTBs) and leukotriene B4 (LTB4). Recent
studies have also demonstrated a relative low production of lipoxin A4, an endogenous lipid
mediator resulting from lipo-oxygenase action, distinct from CystLTBs, with anti-inflammatory
properties, in bronchial epithelial cells and lung macrophages of severe asthma patients,
leading to imbalance between pro-resolving and pro-inflammatory eicosanoids production in
airways. Such data suggest that aspirin, that induces lipoxins production, could restore
lipoxins deficit in severe asthma. Interest for aspirin is also supported by data obtained in
asthma patients with aspirin intolerance (Aspirin induced asthma, AIA) : in this particular
group of patients, aspirin treatment significantly improves nasal symptoms, quality of life,
asthma and rhinitis scores, and reduces need for hospitalizations, nasal surgery and oral
steroids use. Potential effect of aspirin in patients with uncontrolled asthma without
aspirin intolerance, who presented changes in arachidonic acid pathway close to those
observed in AIA, is not established.
The aim of the study is to assess whether long term aspirin treatment could improve asthma
control, compared to placebo, in patients with uncontrolled disease and nasal polyposis,
whatever their aspirin tolerance level.