Medication Related Asthma Triggers

Medications trigger a minority of asthma attacks, but the reactions can be serious.1 The three groups of medication most likely to cause a reaction are aspirin/NSAIDs, beta-blockers, and ACE inhibitors. However, reactions can occur with other drugs as well. Pay attention to any symptoms that start when you take a new medication.2 Report any medication-related asthma attacks to your health care provider.

Aspirin and NSAIDs

Aspirin is also called acetylsalicylic acid or ASA. It belongs to a group of medications called NSAIDs, which stands for non-steroidal anti-inflammatory drugs. Other common NSAIDs are naproxen (ex: Aleve) and ibuprofen (ex: Advil, Motrin). Aspirin and NSAIDs are used to treat inflammation, fever, and pain. Some people take aspirin to protect themselves against heart disease.1

Aspirin-induced asthma usually starts in adulthood. The first sign is an ongoing sinus infection, followed by a diagnosis of asthma and a reaction to aspirin. Eventually, nearly everyone with this kind of asthma develops nasal polyps, or soft growths in the nasal passages.1

An aspirin/NSAID reaction usually starts within minutes or up to two hours of taking the medication.3 Symptoms are: runny or stuffy nose, itchy eyes, swelling or hives, stomach pain, and trouble breathing.1,4 About 6% of people go into shock. Their blood pressure drops and they lose consciousness.1

Aspirin-induced asthma is diagnosed based on history and an aspirin challenge.1,5 These challenges are done in facilities that can handle emergencies.

How common is aspirin sensitivity?
Between 2% and 25% of adults with asthma are sensitive to aspirin.5 The sensitivity usually develops between ages 29 and 34 years.1 Women are more than twice as likely as men to have an aspirin sensitivity. Aspirin-induced asthma is more common in people with severe asthma.6

What are alternatives to aspirin and NSAIDs?
People with aspirin-induced asthma can either avoid these medications or undergo aspirin desensitization. If you chose to avoid the medications, your health care provider can recommend safe alternatives to take for pain and inflammation.3

Aspirin desensitization leads to improvements in about 60% of people.5 The process takes two to four days and is done in a specialized facility.4 You are given a very low starting dose of aspirin. The next dose you are given is slightly higher. Increasing doses are given until all the reactions disappear.1 After aspirin desensitization, you will need to take aspirin daily to maintain the effect.

Beta-Blockers

Beta-blockers are used to treat high blood pressure, heart disease, migraine headaches, hyperthyroidism, generalized anxiety, and essential tremor.1,2 They are also found in eye drops used for glaucoma. Examples are propranolol (ex: Inderal, Innopran), atenolol (ex: Tenormin, Tenoretic), and metoprolol (ex: Lopressor, Toprol, Dutoprol).

Beta receptors receive messages from signaling chemicals in your body and pass that message along. Beta-blocker medications prevent that message from being received.

There are two kinds of beta receptors in your body: beta-1 and beta-2. Your heart has more beta-1 receptors. Your airway has more beta-2 receptors.1 Non-selective beta-blockers block both types of receptors. There are other beta-blockers that target the beta-1 receptors in your heart. These are called “cardioselective” beta-blockers.

It is a general recommendation that people with asthma do not take “non-selective” beta-blockers.6 Non-selective beta-blockers cause asthma symptoms in people with asthma. They cause the airways to narrow and become more sensitive. On average, they cause lung function to decline by 13.5%.1 Cardioselective beta-blockers may be fine to use.1

How common are beta-blocker reactions?
Nearly everyone with asthma reacts to non-selective beta-blockers.1 For this reason, the National Heart, Lung, and Blood Institute recommends that people with asthma avoid using non-selective beta-blockers.6

What are alternatives to using non-selective beta-blockers?
Beta-blockers are often used after a heart attack to improve survival and quality of life.1 If your health care provider thinks you could benefit from taking a beta-blocker, he or she can recommend a “cardioselective” beta-blocker. These medications target the beta-1 receptors in your heart.1,6

ACE Inhibitors

ACE inhibitors are used to treat high blood pressure, heart disease, and kidney disease related to diabetes.1,2 Examples are lisinopril (ex: Prinivil, Zestril) and enalapril (ex: Vasotec).2

The main side effect of taking an ACE inhibitor is cough.1 Even people without asthma may cough while taking an ACE inhibitor. The cough sounds dry, persistent, and hacking. It may be worse at night or when lying down. The cough might begin within a day or several months after starting the ACE inhibitor.1 The cough may continue for days or up to 4 weeks after stopping the medication.

Despite the cough, ACE inhibitors are considered generally safe for most people with asthma.1 The cough does not cause lung function to decrease or airways to be more sensitive. The cough does not improve by taking a rescue medication.

How common are ACE inhibitor reactions?
About 10% to 20% of people cough while taking an ACE inhibitor.1 Women are three times more likely than men to have this side effect.

What are alternatives to using ACE inhibitors?
ACE inhibitors do not cause lung function to decrease.1 Therefore, people with asthma may be able to take these medications if they are necessary. If one ACE inhibitor causes cough, others probably will too.1 Your health care provider may be able to recommend a different type of medication to treat your condition. You may also be able to take medications that reduce coughing.

Written by: Sarah O'Brien | Last Reviewed: May 2016.
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