Fever and pain are bad enough, but if you accidentally trigger an asthma attack while trying to treat these symptoms, it can be dangerous. Aspirin and ibuprofen are over-the-counter medications commonly used to reduce fever or treat pain and inflammation brought on by many medical conditions. But both of these pain relievers can trigger an allergy-like reaction called aspirin-induced asthma (AIA) and bring on asthma attacks.

Keep reading to learn more about how and why aspirin or ibuprofen might raise the risk of an asthma attack and how to be prepared.

Asthma Attacks

Asthma is a lung disease in which a person’s airways become narrow and swollen, making it difficult to breathe. Sometimes, asthma symptoms can get suddenly worse, leading to an asthma attack. During an asthma attack, a person may experience wheezing, coughing, shortness of breath, and chest pain. Asthma attacks are often set off by coming into contact with triggers — things that irritate the lungs. Avoiding things that trigger asthma is important in keeping asthma attacks at bay.

Nonsteroidal Anti-Inflammatory Drugs

Aspirin and ibuprofen belong to a group of pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs include acetylsalicylic acid (aspirin), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). Also known as COX inhibitors, they work by blocking the actions of COX-1 and COX-2 enzymes, which have a role in the production of prostaglandins. When the COX enzymes are blocked by a medication, like a COX inhibitor, it decreases the amount of a hormone-like substance called prostaglandin, which causes inflammation in the body.

Because of their low cost and wide availability, NSAIDs are commonly used to relieve pain and inflammation associated with:

• Arthritis
• Muscle and joint pain
• Dental pain
• Headaches
• Menstrual cramps
• Fever from cold and flu

Although the pain reliever acetaminophen (Tylenol) isn’t an NSAID, some research shows it may also increase the chances of asthma and asthma attacks in children.

Aspirin-Induced Asthma

In about 10 percent to 20 percent of adults and 5 percent of children with asthma, aspirin or other NSAIDs including ibuprofen trigger aspirin-induced asthma (AIA). It’s a condition in which asthma attacks are brought on as a reaction to taking aspirin or other NSAIDs.

In people with AIA, NSAIDs cause the body to make too many leukotrienes. Leukotrienes are molecules released by the immune cells that cause excess mucus and narrowing of the airway in an asthma attack.

Symptoms of AIA appear within 30 minutes to three hours of taking the medication. In addition to the common symptoms of asthma attacks — wheezing, coughing, and shortness of breath — symptoms of AIA may include:

• Sneezing
• Runny nose
• Congestion
• Allergic rash
• Swelling or hives on the face

These initial symptoms may be followed by nasal polyps (swelling and growths in the lining of the nose) and the development of sensitivity to aspirin or other NSAIDs in the days and months after the initial reaction.

Some people with AIA develop a condition called aspirin-exacerbated respiratory disease (AERD), also known as Samter’s triad. AERD is characterized by three key factors — asthma, nasal polyps, and history of a reaction to aspirin or other NSAIDs. About 10 percent to 20 percent of adults with asthma and 30 percent to 40 percent of adults with asthma and nasal polyps have AERD.

How Is Aspirin-Induced Asthma Diagnosed?

There are no blood or skin tests that can diagnose sensitivity to aspirin and other NSAIDs. Diagnoses are made based on the person’s history of their reaction to the medications. In many cases, aspirin sensitivity doesn’t show up in people with asthma until their 20s to 30s. Even if a person has taken NSAIDs without a reaction in the past, it doesn’t rule out the risk of a reaction later on.

One way to find out whether someone has a sensitivity to aspirin or other NSAIDs is to do an aspirin challenge test. In an aspirin challenge test, a person is exposed to increasing small doses of aspirin or other NSAIDs under medical supervision to see if they develop a reaction. The challenge test must be carried out under close medical monitoring, as even a small dose can trigger a severe reaction.

How Is Aspirin-Induced Asthma Treated?

Treatment of AIA involves short-term relief of asthma symptoms with medications and a long-term treatment of sensitivity to aspirin or other NSAIDs using a technique known as aspirin desensitization.

Asthma Management

The symptoms of AIA are treated with the same methods used for asthma attacks. They include:

• Rescue medications to bring quick relief in acute asthma attacks
• Maintenance medications to control and prevent symptoms over the long term
• Corticosteroids used with other medications to control ongoing symptoms

Leukotriene Modifiers

Leukotriene modifiers can also be used as a preventive treatment to manage AIA symptoms. Leukotriene modifiers, such as montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo), prevent swelling and narrowing of the airway that occur in asthma attacks.

Aspirin Desensitization

Aspirin desensitization is a long-term treatment that can help people with a known sensitivity to aspirin and other NSAIDs build a tolerance. During aspirin desensitization, a person with sensitivity to aspirin or other NSAIDs is exposed to gradually increasing doses of the medication under close medical monitoring.

As the person builds a tolerance to larger doses of the medication, they should have less severe reactions. Once the full dose is reached, the person is exposed to the same dose every day to prevent symptoms from returning. In one study from the Journal of Allergy and Clinical Immunology, 87 percent of people who underwent aspirin desensitization felt it improved their asthma symptoms.

How Is Aspirin-Induced Asthma Prevented?

As with asthma in general, avoiding the triggers that can bring on attacks is the best defense against AIA. Consider alternatives to NSAIDs to treat fever, pain, and inflammation.

Beta-blockers and ACE inhibitors are other medication classes that can trigger asthma symptoms. Be sure to read labels carefully before taking medications. Be aware that NSAIDs may be used in combination with other medications in some over-the-counter cold and flu medicines.

Alternative Pain and Inflammation Relief

An alternative option for pain relief might be COX-2 inhibitors. Also known as selective NSAIDs, they work by blocking only the COX-2 enzyme.

COX-2 inhibitors — such as celecoxib (Celebrex) — cause fewer stomach and intestinal problems or respiratory reactions than traditional NSAIDs. However, COX-2 inhibitors may increase the chance of heart attack or stroke, so be sure to check with your provider before taking them.

There are also nonmedication alternatives for pain relief, including:

• Ice packs — Relieve swelling in injury sites
• Hot pads — Promote blood flow to old injuries or arthritis
• Stretching and exercise — Relieve muscle stiffness and pain
• Acupuncture — Improves recurring pain
• Relaxation techniques — Improve stress-related pain such as headaches

Have an Asthma Action Plan Ready

If you have asthma, talk to your providers about creating an asthma action plan. Your own written asthma action plan will guide you on how to respond in case of an asthma attack. It has information on all your asthma medications and when to take them, depending on the severity of your symptoms. It also tells you when to get medical help. Several MyAsthmaTeam members emphasized the importance of having an action plan for asthma attacks.

One member said, “It can happen anytime and anywhere, and you always need to be prepared.” Another echoed, “If you don’t have an asthma action plan, get one! Always be prepared — you never know when an attack will happen.”

Working closely with your health care provider to develop a personalized asthma action plan is important for effectively managing your condition. This approach ensures that you have a clear understanding of your asthma triggers, medications, and what steps to take during different situations. By following this plan diligently, you can control your asthma and reduce the chances of it getting worse.

Although both aspirin and ibuprofen are commonly used over-the-counter medications for pain relief and inflammation, they can trigger asthma attacks. It is essential to be aware of the risks associated with these medications, particularly if you have a known history of asthma or respiratory issues. If you think you will experience side effects, consult with your health care provider for alternative treatment options.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Are you living with aspirin-induced asthma? Share your experience in the comments below, or start a conversation by posting on your Activities page.