Is ibuprofen (nonsteroidal anti-inflammatory drug, NSAID) contraindicated in patients with asthma?

From the Guidelines

Ibuprofen is not absolutely contraindicated in all asthma patients, but it should be used with caution, as it may exacerbate asthma in certain individuals, particularly those with aspirin-exacerbated respiratory disease (AERD) 1. When considering the use of ibuprofen in patients with asthma, it is essential to weigh the potential benefits against the risks. Key points to consider include:

• Patients with AERD, which affects approximately 7-20% of adult asthmatics, should avoid ibuprofen and other NSAIDs as these medications can trigger severe bronchospasm and asthma attacks 1.
• The mechanism behind this reaction involves the inhibition of cyclooxygenase-1 (COX-1) enzyme by NSAIDs, which shifts arachidonic acid metabolism toward the lipoxygenase pathway, increasing production of leukotrienes that can trigger bronchospasm.
• If a patient with asthma has previously taken ibuprofen without any respiratory symptoms, they can likely continue using it safely.
• However, the first dose of any NSAID should ideally be taken in a monitored setting if there's uncertainty about potential sensitivity.
• Patients with asthma should always inform their healthcare providers about their condition before taking new medications, including ibuprofen, to ensure safe use and minimize potential risks 1. Some important considerations for healthcare providers include:
• Reviewing the patient's medical history and current medications to identify potential interactions or contraindications.
• Adjusting medications as necessary to address coexisting medical conditions, such as arthritis or hypertension.
• Educating patients about the potential risks and benefits of ibuprofen use in asthma and providing guidance on safe use and monitoring.

From the FDA Drug Label

Ibuprofen tablets should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with preexisting asthma Patients with asthma may have aspirin-sensitive asthma The use of aspirin in patients with aspirin-sensitive asthma has been associated with severe bronchospasm, which can be fatal Since cross reactivity, including bronchospasm, between aspirin and NSAIDs has been reported in such aspirin-sensitive patients, Ibuprofen tablets are contraindicated in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.

Ibuprofen is contraindicated in patients with a history of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs. However, for patients with preexisting asthma who do not have aspirin-sensitive asthma, ibuprofen can be used with caution 2.

From the Research

Ibuprofen and Asthma

• Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can cause asthma exacerbations in some individuals, particularly those with a history of aspirin-intolerant asthma (AIA) 3, 4.
• The exact mechanism of ibuprofen-induced asthma exacerbations is not fully understood, but it is thought to involve the inhibition of cyclo-oxygenase and the overproduction of cysteinyl leukotrienes (cys-LTs) 3.
• Studies suggest that approximately 10% of adults with asthma and a smaller proportion of children with asthma may experience deterioration in respiratory function after taking NSAIDs, including ibuprofen 4.
• However, the risk of ibuprofen-induced asthma exacerbations in children is considered low, and some studies suggest that ibuprofen may even have therapeutic benefits for some children with asthma 5.

Contraindications and Precautions

• Patients with a history of aspirin-intolerant asthma (AIA) or those with high-risk clinical features for intolerance to NSAIDs (severe asthma, nasal polyps, or chronic rhinosinusitis) should use ibuprofen only under close medical supervision 3, 4.
• Formal aspirin provocation testing may be recommended prior to the therapeutic use of NSAIDs in individuals with high-risk features 4.
• A case report describes a fatal asthma attack induced by ibuprofen in a patient with a history of asthma, highlighting the potential risks of NSAID use in susceptible individuals 6.

Clinical Recommendations

• Patients with asthma who are known to be intolerant of NSAIDs or who exhibit high-risk clinical features should avoid the use of ibuprofen or use it only under close medical supervision 3, 4.
• Individuals with asthma who do not exhibit high-risk features and have never before used NSAIDs should be treated as potentially intolerant to NSAIDs and use ibuprofen only under medical supervision 4.