Aspirin-Induced Asthma

Reviewed by: HU Medical Review Board | Last reviewed: October 2021

Aspirin-induced asthma is a type of asthma triggered by aspirin. It is also triggered by other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Aspirin-induced asthma is also called aspirin-exacerbated respiratory disease (AERD).1

About 10 percent of adults with asthma are sensitive to NSAIDs. This rate is twice as high for people with severe asthma. About 30 to 40 percent of people with both asthma and nasal polyps are sensitive to NSAIDs.1

Talk to your doctor if you notice symptoms of asthma and sensitivity to aspirin. They can help determine a treatment plan to reduce your symptoms or sensitivity.

What are symptoms of aspirin-induced asthma?

People with aspirin-induced asthma often have 3 conditions. This is called Samter’s Triad. The 3 conditions usually develop over many years. They are:2

  • Asthma
  • Sensitivity to aspirin and other NSAIDs
  • Sinus infection with nasal polyps

An acute reaction starts 30 minutes to 3 hours after taking NSAIDs. Symptoms then peak within 1 to 2 hours and go away within 3 hours. Small doses cause less severe symptoms than larger doses. Possible signs and symptoms of an aspirin-induced reaction include:3

  • Stuffy or runny nose
  • Swollen, watery, or itchy eyes
  • Redness in the face and neck
  • Coughing
  • Wheezing
  • Shortness of breath
  • Chest tightness

Many people with aspirin-induced asthma also have mild reactions to alcohol. These are not all the possible symptoms of an aspirin-induced reaction. More severe symptoms may occur in people with severe asthma.4

What causes aspirin-induced asthma?

Aspirin and other NSAIDs work by blocking an enzyme called COX-1. This reduces inflammation and relieves pain. But blocking COX-1 decreases anti-inflammatory chemicals called prostaglandins. It also increases pro-inflammatory chemicals called leukotrienes. This can lead to acute asthma and allergy-like reactions.4,5

We do not know why some people with asthma are sensitive to NSAIDs. Some NSAIDs that may cause a reaction include:4

  • Aspirin
  • Diclofenac
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Naproxen
  • Piroxicam

These are not all the possible NSAIDs that can cause a reaction. Talk to your doctor if you notice any symptoms after taking any NSAID.

How is aspirin-induced asthma diagnosed?

Doctors diagnose aspirin-induced asthma based on symptoms of 3 conditions:1,4

  • Asthma
  • Visible nasal polyps
  • History of respiratory symptoms after NSAID exposure
  • A diagnosis can be harder if you have only asthma or only nasal polyps. In this case, doctors will do a detailed analysis of symptom history. They may also perform an aspirin challenge.1,4

    How is aspirin-induced asthma treated?

    Managing aspirin-induced asthma involves typical asthma treatment methods. This includes inhaled corticosteroids, like in other types of asthma. It also includes drugs called leukotriene receptor agonists. These drugs block the action of leukotrienes. This helps prevent inflammatory reactions to NSAIDs.1,4

    Treatment also includes managing the sinus infection and removing nasal polyps. This may include medical and surgical techniques.1,4

    Many people with aspirin-induced asthma undergo aspirin desensitization. This is a procedure that can make you less sensitive to NSAIDs. Your doctor will give you increasing doses of aspirin until you reach the highest dose without a reaction. You will then continue on a daily dose of aspirin to prevent your symptoms from coming back.1,4

    If you stop the daily dose for any reason, your symptoms will return, and you will need to undergo the desensitization again. Desensitization can improve symptoms and quality of life.1,4

    If you do not undergo aspirin desensitization, you must avoid NSAIDs. Sinus infections and nasal polyps may continue if NSAIDs are avoided. Talk to your doctor about other pain-relievers to take instead of aspirin. This may include:1,4

    • Weaker NSAIDs
    • Lower doses of acetaminophen
    • Celecoxib

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