Is Brufen (ibuprofen) prescribed in patients with bronchial asthma?

Ibuprofen (Brufen) Should Not Be Prescribed to Patients with Bronchial Asthma

Ibuprofen (Brufen) is contraindicated in patients with bronchial asthma who have experienced aspirin-sensitive asthma due to the risk of severe, potentially fatal bronchospasm. 1

Mechanism and Risk

Ibuprofen, like other NSAIDs, can trigger bronchospasm in patients with asthma through cross-reactivity with aspirin. This reaction is particularly dangerous in:

• Patients with known aspirin-sensitive asthma
• Patients with a history of NSAID-induced respiratory symptoms
• Patients with severe asthma, especially those with nasal polyps or chronic rhinosinusitis

The FDA drug label explicitly states that ibuprofen "should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs" as "severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients." 1

Prevalence of Risk

The risk of cross-reactivity between aspirin and NSAIDs like ibuprofen affects:

• Approximately 20-30% of patients with aspirin-sensitive asthma 2
• Up to 2% of asthmatic children, increasing to nearly 30% in older children with severe asthma and nasal disease 3

Documented Severe Outcomes

Case reports have documented fatal outcomes from ibuprofen use in asthmatic patients. One report describes a 40-year-old woman with lifelong asthma who died after ingesting just 400 mg of ibuprofen, despite having no prior history of aspirin or NSAID sensitivity 4. Another case documents a severe asthma exacerbation in a 17-year-old boy following ibuprofen administration 3.

Alternative Medications for Asthma Management

The British Thoracic Society and other guidelines recommend the following medications for asthma management instead:

1. For bronchodilation:

   • Salbutamol (nebulized, 5 mg or 0.15 mg/kg)
   • Terbutaline (nebulized, 10 mg or 0.3 mg/kg)
   • Ipratropium bromide (nebulized, 250 μg six hourly) 5

2. For inflammation control:

   • Inhaled corticosteroids as the cornerstone of therapy for persistent asthma 6
   • Oral corticosteroids (prednisolone 2 mg/kg/day for three days, max 40 mg/day) for acute exacerbations 5

3. For pain management in asthmatics:

   • Paracetamol (acetaminophen) is generally considered safer, though it should be used with caution as it may cross-react with aspirin in approximately 20-30% of sensitive patients 2
   • Opioids and tramadol are suitable analgesic alternatives for patients with known or suspected susceptibility 3

Special Considerations

If analgesic therapy is absolutely necessary in an asthmatic patient:

1. Perform oral provocation tests before recommending any NSAID, including paracetamol, to confirm safety 2
2. Consider COX-2 selective inhibitors as potentially safer alternatives, though this remains controversial 3
3. Monitor closely for any signs of respiratory distress if any NSAID must be used

Conclusion

Given the potential for severe, life-threatening reactions, including documented fatalities, ibuprofen (Brufen) should be avoided in patients with bronchial asthma, particularly those with known or suspected aspirin sensitivity. The risk of triggering a severe asthma exacerbation outweighs the potential benefits when safer alternative medications are available.