From the Guidelines
NSAIDs should be used with caution in people with asthma, as they can trigger bronchospasm, wheezing, and severe asthma attacks in susceptible individuals, affecting about 7-20% of asthmatics, as reported in 1 and 1. When considering the use of NSAIDs in asthmatic patients, it is essential to weigh the potential benefits against the risks, particularly the risk of NSAID-exacerbated respiratory disease (NERD).
- Common NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin can trigger severe asthma attacks in susceptible individuals.
- The mechanism behind this reaction involves the inhibition of the cyclooxygenase-1 (COX-1) enzyme, shifting arachidonic acid metabolism toward the lipoxygenase pathway, which increases production of leukotrienes that can cause airway constriction, as mentioned in 1.
- For pain relief in asthmatics, acetaminophen (Tylenol) is typically the safer first-line option at standard doses (325-650 mg every 4-6 hours, not exceeding 3000 mg daily).
- If an NSAID is absolutely necessary, it should only be used under medical supervision after risk assessment, considering the patient's history and the potential for adverse effects, as discussed in 1.
- COX-2 selective inhibitors like celecoxib (Celebrex) may be safer alternatives in some cases but should still be used cautiously, as their safety profile is not entirely established in asthmatic patients, according to 1.
- Any asthmatic experiencing worsening symptoms after taking an NSAID should stop the medication immediately and seek medical attention, emphasizing the need for close monitoring and patient education, as highlighted in 1.
From the FDA Drug Label
Do not take an NSAID medicine: if you had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine
- NSAIDs can exacerbate asthma symptoms in people who have a history of asthma attacks, hives, or other allergic reactions to NSAIDs.
- People with asthma should exercise caution when taking NSAIDs, as they may trigger or worsen asthma symptoms.
- It is recommended to consult a healthcare provider before taking NSAIDs, especially for individuals with a history of asthma or other allergic reactions 2.
From the Research
NSAIDs and Asthma
- NSAIDs can exacerbate asthma symptoms in some individuals, particularly those with aspirin sensitivity 3
- Aspirin sensitivity is more common in people with asthma, affecting up to 20% of this population 3
- Non-aspirin NSAIDs can also trigger asthma attacks due to cross-sensitivity with aspirin 3
- Paracetamol (acetaminophen) is generally well-tolerated by people with asthma and is less likely to cause cross-sensitivity 3
Prescription Considerations
- Healthcare practitioners should take a proactive stance in determining whether aspirin sensitivity is a problem for patients with asthma 3
- Patients with asthma should be counseled about the risks of NSAIDs and helped to make an appropriate analgesic choice 3
- The prescription of NSAIDs should be carried out with caution, considering the treatment duration and the patient's situation, due to the increased risk of hepatotoxicity, kidney damage, and exacerbation of heart failure 4
Specific NSAIDs and Asthma
- Aspirin should be avoided in patients with asthma and nasal polyps who are naïve to aspirin therapy 5
- Ibuprofen may be a suitable option for patients with asthma who do not have concomitant coronary artery disease, heart failure, or renal disease 5
- The choice of NSAID should be dictated by comorbid conditions, tolerability, and adverse effects 5