Medication-Related Asthma Triggers

Some medicines can worsen asthma or trigger asthma symptoms. These include:¹

• Aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs)
• Beta-blockers
• ACE (angiotensin-converting enzyme) inhibitors

These are not the only medicines that can cause asthma symptoms. Talk to your doctor if you notice asthma symptoms after starting a new medicine. They can suggest ways to treat or avoid your sensitivity. Do not stop taking any medicine before talking to your doctor.¹

Aspirin and NSAIDs

Aspirin is also called acetylsalicylic acid. It is a common NSAID. These drugs relieve inflammation and pain. They block an enzyme called cyclooxygenase (COX). There are 2 forms of COX: COX-1 and COX-2.²

About 1 in 10 adults with asthma are sensitive to NSAIDs. This is called aspirin-exacerbated respiratory disease (AERD). People with AERD may also have sinus infections and nasal polyps. AERD is more common in people with severe asthma.^2,3

Reactions to NSAIDs start in minutes to hours of taking the drug. We do not know why this reaction happens. People with AERD may have high levels of chemicals that promote inflammation in their bodies. These chemicals are called leukotrienes. NSAIDs that block COX-1 may make these levels even higher. This may lead to airway inflammation and asthma symptoms.²

Aspirin and many other NSAIDs block COX-1 or both COX forms. These include:^1-3

• Aleve^® and Naprosyn^® (naproxen)
• Advil^® and Motrin^® (ibuprofen)

Doctors diagnose aspirin sensitivity using your symptoms and an aspirin challenge. An aspirin challenge is when you get aspirin at the doctor's office and are watched for a reaction. Treatment then involves inhaled corticosteroids. You may also undergo aspirin desensitization. This leads to improvement for most people.^2,4

If you do not undergo desensitization, you must avoid NSAIDs that block COX-1. Your doctor can suggest other pain relievers that are safer, such as:^2,3,5

• Low doses of Tylenol^® (acetaminophen), which is not an NSAID
• Celebrex^® (celecoxib), which only blocks COX-2

Beta-blockers

Doctors prescribe beta-blockers to treat many conditions, including:⁵

• High blood pressure
• Heart disease
• Migraine
• Overactive thyroid (hyperthyroidism)
• Generalized anxiety

Beta-blockers block proteins on your cells called beta receptors. Hormones bind to these proteins to activate your “flight or fight” stress response. Blocking this process helps reduce your blood pressure and slow down your heartbeat.⁶

There are 2 kinds of beta receptors: beta-1 and beta-2. Beta-2 receptors are found more in the airway. Beta-1 receptors are found more in the heart. Nonselective beta-blockers block both types of receptors. Cardioselective beta-blockers are more specific for beta-1 receptors.⁶

Most people with asthma can take beta-blockers without asthma flares. However, some people with asthma should not take nonselective beta-blockers. These can cause airway narrowing and asthma symptoms. Nonselective beta-blockers include:^1,7,8

• Visken^® (pindolol)
• Timol^® and Blocadren^® (timolol)
• Corgard^® (nadolol)
• Inderal^® (propranolol hydrochloride)

Cardioselective beta-blockers may be an option. These do not seem to affect the airway as much. Ask your doctor if the benefits outweigh the risks. Cardioselective beta-blockers include:^6,7

• Sectral^® (acebutolol)
• Tenormin^® (atenolol)
• Lopressor^® (metoprolol)

ACE inhibitors

Doctors prescribe ACE inhibitors to treat many conditions, including:⁷

• High blood pressure
• Heart disease
• Kidney disease related to diabetes

Some examples of ACE inhibitors include:¹

• Vasotec^® (enalapril)
• Capoten^® (captopril)
• Prinivil^® and Zestril® (lisinopril)

About 10 to 20 percent of people taking ACE inhibitors experience coughing as a side effect. It is usually a dry and persistent cough. It may start within days to months of taking an ACE inhibitor.^7,8

For people with asthma, ACE inhibitors increase the risk of cough. This can be confused with coughing caused by asthma. But coughing caused by ACE inhibitors will not respond to typical asthma treatments.⁷

ACE inhibitors are usually safe for people with asthma. Asthma does not increase the risk of coughing as a side effect of ACE inhibitors. ACE inhibitors do not affect lung function or increase airway sensitivity for people with asthma.⁷

Talk to your doctor if your ACE inhibitor is worsening coughing. They may recommend other treatment options. These may include angiotensin receptor blockers or calcium channel blockers.⁷