Many persons with asthma have been told — by physicians or by friends and family members — never to take aspirin. Why? Others with asthma take aspirin on occasion or even every day without any difficulty. What is the relationship between asthma and aspirin and other aspirin-like medications (for example, ibuprofen)? Should you too avoid taking aspirin, and if so, what alternative medications are safe to use?

Aspirin can cause a severe asthmatic attack in some persons sensitive to this class of medication.

Some persons with asthma will develop an asthma attack after taking aspirin. The attack can be very severe and sometimes life-threatening. It comes on within 3 hours after swallowing the tablet(s) and involves all the usual symptoms of severe asthma: cough, wheezing, chest tightness, and difficulty breathing. It often is accompanied by other symptoms as well, particularly nasal congestion and runny nose, swelling around the eyes, and sometimes abdominal pains.

Only about five out of 100 persons with asthma are sensitive to aspirin in this way. Ninety five out of 100 persons with asthma will be able to take aspirin and related medications without any effect on their asthma. Children with asthma rarely have aspirin sensitivity, and it does not tend to run in families. Many people with asthma and aspirin sensitivity will also have nasal congestion and polyps in their nose.

Only about 5 out of every 100 persons with asthma are sensitive to aspirin in this way.

No one knows for sure why a few persons with asthma develop this sensitivity in their adulthood. It seems somehow to relate to a chemical imbalance that leads to the excessive production of leukotrienes (pronounced: lew - ko -TRY - eens). Leukotrienes are chemicals released into the airways by allergy cells in the bronchial tubes of persons with asthma. They cause spasm of the bronchial muscles and swelling of the walls of these tubes. It remains a mystery why some persons with asthma make large amounts of leukotrienes after taking aspirin, whereas most do not.

The answer is not a simple "allergy" to aspirin, because persons sensitive to aspirin in this way will also be sensitive to the related medications called "non-steroidal antiinflammatory drugs" or NSAIDs. Common NSAIDs available without a prescription include ibuprofen (Advil® and Motrin®) and naproxen (Aleve®). A more complete list of aspirin-containing medications and NSAIDs is provided in the accompanying table. What all of these medicines have in common is their chemical effect: they inhibit the action of one of the proteins in the body, called cyclooxygenase. Persons with asthma and aspirin sensitivity have an unexplained sensitivity to the inhibitors of cyclooxygenase. It is as of yet uncertain how the new class of cyclooxygenase inhibitors used to treat arthritis (Vioxx® and Celebrex®) will affect persons with aspirin-sensitive asthma. [Early evidence suggests that they are safe for use by persons with aspirin-sensitive asthma, at least in low doses.]

If your asthma is sensitive to aspirin, it is also sensitive to all of the related medications, called “non-steroidal antiinflammatory drugs.”

There is no simple test to determine if you have aspirin sensitivity, other than your own past experience with having taken aspirin or any of the NSAIDs. If as an adult you have never taken aspirin or a NSAID, perhaps because your doctor told you to avoid it because of your asthma, then you have two options. One is to continue to avoid aspirin and related medications on the possibility that your asthma involves aspirin sensitivity (a chance of about one in 20) or to take a small test dose of aspirin in a safe place, preferably your doctor's office, and have your breathing closely observed for three hours thereafter.

There is no simple test for aspirin sensitivity – other than your own past experience.

Avoidance is most important.

Treatment of asthma in persons with aspirin sensitivity is the same as for all other persons with asthma. Medications that block leukotrienes (namely, Accolate®, Singulair®, and Zyflo®) may be particularly helpful. Most important is the care that needs to be taken to avoid all medications that contain aspirin and NSAIDs. Many over-the-counter pain relievers, as well as cold, flu, and sinus remedies, contain aspirin. If you have aspirin-sensitive asthma, you need to become a careful "bottle reader," checking all the medication ingredients before taking any new treatment. In general, persons with aspirin-sensitive asthma can safely take Tylenol® (generic name: acetaminophen). It is also possible to be "desensitized" to aspirin, a procedure that requires close medical supervision and then daily ingestion of aspirin. Because aspirin desensitization carries with it the risk of triggering a severe attack of asthma, it is not part of routine care.

Over-the-Counter Medications

Aspirin

• Ascriptin

• Empirin

• Bufferin

• Halfprin

• Ecotrin

Non-Steroidal Antiinflammatory Drugs

• Actron

• Ibuprohm

• Advil

• Motrin IB

• Aleve

• Nuprin

• Ibuprofen

• Orudis KT

Aspirin-Containing Medications

• Alka Seltzer Plus

• Doan's

• Anacin

• Excedrin

• Aquaprin

• Goody's Headache Powders

• Bayer Children's Cold Tablet

• Stanback Headache Powders

• BC Powder

• St. Joseph Cold Tablet for Children

• Cama Arthritis Pain Reliever

• Vanquish

• Cope

Prescription Medications

Aspirin-Containing Medications

• Easprin

• Percodan

• Fiorinal

• Zoprin

Non-Steroidal Antiinflammatory Drugs

• Anaprox

• Nalfon

• Ansaid

• Naprosyn

• Clinoril

• Orudis

• Daypro

• Oruvail

• Disalcid

• Ponstel

• Feldene

• Relafen

• Indocin

• Tolectin

• Lodine

• Toradol

• Meclomen

• Voltaren

• Motrin