Up to 20 percent of people with asthma are sensitive to aspirin and most other nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used as pain medications. These drugs can result in severe, hard-to-control attacks for people who are sensitive to them.
A reaction to aspirin and related drugs is not a true allergy, although some of the effects on the body are the same. Rather, the reason that these medicines worsen asthma relates to the way that they work. To control pain, these drugs prevent a natural fat in cell membranes (an essential fatty acid named arachidonic acid) from converting into the substance prostaglandin. A lower level of prostaglandin leads to less pain. However, arachidonic acid can accumulate in the first few hours after you take the medicine, and eventually it can convert to a chemical messenger that is an important trigger of inflammation. That trigger is yet another natural substance called a leukotriene.
If you have a lot of leukotrienes in your system, they can trigger asthma by causing inflammation in the airways and making the airways create mucus. They also can cause eye tearing and sinus symptoms, such as a runny or stuffy nose. Occasionally they cause swelling of the tongue and tissues in and around the mouth and throat. This swelling, called angioedema, is a dangerous problem because it may block breathing. Sensitivity to aspirin and related drugs is one reason that people can form nasal polyps (bulges of swollen tissue that grow from the lining of the nasal passages).
It is likely that everyone who uses these medicines forms a few extra leukotriene molecules. The people who make the most leukotrienes are the people who are likely to have aspirin-induced asthma and other symptoms from aspirin and most other NSAID drugs. Typical timing is for this sensitivity to begin in adults who are between 20 and 40 years old.
In addition to aspirin, over-the-counter NSAIDs include ibuprofen (common brand names are Advil and Motrin) and naproxen (Aleve). Examples of prescription NSAIDs include sulindac (Clinoril), diclofenac (Voltaren), piroxicam (Feldene), ketoprofen (Orudis), diflunisal (Dolobid), nabumetone (Relafen), etodolac (Lodine), oxaprozin (Daypro) and indomethacin (Indocin).
The type of NSAID that is called a COX-2 inhibitor, celecoxib (Celebrex), has been tested in aspirin-sensitive people, and it appears that this drug will not trigger an increase in leukotrienes for most individuals. More studies will need to confirm the safety of this medication. However, if you need to take an anti-inflammatory pain medicine, you and your physician may consider using this type of NSAID with careful observation for symptoms.
To identify products containing aspirin or NSAIDs, carefully review the active-ingredient list or ask your pharmacist. Products that contain aspirin or NSAIDs that could trigger asthma attacks include:
- Some cold tablets
- Medications for menstrual symptoms
- Prescription drugs containing aspirin, such as the painkillers Darvon Compound-65 and Percodan, and the headache remedy Fiorinal.
An acetaminophen product such as Tylenol, Panadol or Aspirin-Free Anacin is usually recommended for aspirin-sensitive asthmatics, as acetaminophen much more rarely causes asthma symptoms.
Even though aspirin is a salicylate, other salicylate medicines (such as Disalcid) and salicylates in food do not appear to aggravate asthma in aspirin-sensitive patients. If you are aspirin sensitive, you must always warn your health care provider before receiving any pain medications.
If you have asthma or eye and sinus symptoms that are triggered by aspirin or NSAIDs, then your asthma may improve if you are treated with a drug that specifically blocks the effect of leukotrienes. Medicines known as leukotriene modifiers include zileuton (Zyflo), montelukast (Singulair) and zafirleukast (Accolate).
Drugs called beta-blockers may cause or worsen asthma in some people by causing the airway muscles to tighten. These drugs are used to treat migraine headaches, glaucoma, irregular heart rhythm, high blood pressure, tremors and other conditions. They are commonly prescribed to people who have had a heart attack. If you are prescribed beta-blockers, make sure your doctor is aware you have asthma; an alternate drug may be substituted.
