Many people with asthma have sensitivities to certain drugs that can precipitate an asthma attack. If you have asthma, you need to be aware of which medications may be triggers. You do not need to avoid these medications unless you know they are asthma triggers for you. If these medications have never triggered your asthma, it is still best to take the medications with caution because a reaction can occur at any time.
Below is a list of the most common medications known to trigger symptoms of asthma. However, if you are prescribed any medication that you think may be causing your asthma to worsen, discuss it with your doctor.
- A) Aspirin and other painkillers. Approximately 10% to 20% of adults with asthma have sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs -- or NSAIDS -- such as ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn). These drugs are frequently used to treat pain and reduce fevers.
Asthma attacks caused by any of these medications can be severe and even fatal, so these drugs must be completely avoided in people who have known aspirin sensitive asthma. Products with acetaminophen such as Tylenol are considered safe for people who have asthma. It is important that people with aspirin sensitivity read labels of all over-the-counter drugs used to treat pain, colds and coughs, and fever. Also inform your doctor so that these medications are not prescribed for you. If you have any questions whether a certain medication could trigger your asthma, seek advice from your health care provider.
- B) Aspirin Sensitivity, Asthma, and Nasal Polyps. Some people with asthma cannot take aspirin or NSAIDs because of what’s known as Samter’s triad -- a combination of asthma, an allergic reaction to aspirin, and nasal polyps. Nasal polyps are small growths that form from long-term inflammation of the lining of the nasal cavity.
This aspirin sensitivity occurs in about 10% to 20% of people with asthma and 30% to 40% of those who have asthma and nasal polyps. Many people who are sensitive to aspirin and NSAIDs have nasal symptoms, such as runny nose, postnasal drip, and congestion, along with asthma symptoms, such as wheezing, cough, and shortness of breath. Talk to your doctor about options other than aspirin and NSAIDs if you have this allergy.
- C) Beta-blockers. Beta-blockers are commonly prescribed medications used to treat numerous conditions including heart conditions, high blood pressure, migraine headache, and, in eye drop form, glaucoma. Your health care provider must determine the need for these medications and you can take a few trial doses to see if they affect your asthma. It is important that you inform all of your health care providers who may need to prescribe these types of medications that you have asthma. This includes even your eye doctor.
Examples of beta-blockers are metoprolol, sotalol, atenolol, carvedilol
- Evidence Concerning Noncardioselective ß Blockers. Multiple studies over the past 20 years demonstrated on average that regular use of nonselective ß blockers (carvedilol) compared with placebo caused a 14% reduction in FEV1 and a 23% decrease in the FEV1 response after ß-2 agonists were given. No significant increase in respiratory symptoms or ß-2 agonist inhaler use was seen in any of the trials. However, the decrease in ß-2-agonist response seen with nonselective ß blockers may indicate an increased risk for a clinically significant adverse effect during an asthma exacerbation.
- Evidence Concerning Cardioselective ß Blockers. Over the past 20 years, non-selective ß blockers have largely been replaced with cardioselective blockers. Cardioselective ß blockers (atenolol, metoprolol) are ~20 times more potent at blocking ß-1 receptors than ß-2 receptors. At therapeutic doses the ß-2 blocking effect, and therefore the risk of bronchoconstriction, is negligible.
- Patients with obstructive airway disease(asthma, COPD, emphysema, bronchiectasis) and concomitant congestive heart failure or ischemic heart disease. it is common practice to give ß-2 agonists while withholding ß blockers. There are studies that have documented an association between ß-2 agonist use and the development of congestive heart failure, acute myocardial infarction, or cardiac death. This association may be explained by ß-agonist stimulation causing tachycardia, hypokalemia (low blood potassium), and arrhythmia, especially in the presence of cardiac comorbidities or hypoxemia (low oxygen).
- D) ACE inhibitors . These are other types of medications used to treat heart disease and high blood pressure. These drugs can cause coughs in about 10% of the patients who use them. This cough is not necessarily asthma. But, it can be confused with asthma or, in the case of unstable airways, can actually trigger wheeze and chest tightness. If you are prescribed an ACE inhibitor and develop a cough, speak with your doctor.
Some ACE inhibitors are Accupril, Enalapril, Captopril, Monopril, Prinivil, Zestril.