Can a person with Asthma take Ibuprofen?

Contents

Generally, yes. However,  if you have not been exposed to Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs), then you should take it with caution.

It is best to consult your GP if you have clinical conditions that suggest an increased risk of sensitivity to Ibuprofen.

Introduction

In the UK, around 5.4 million people are receiving some form of treatment for asthma. That is 1 in 12 adults and 1 in every 11 children.1

Some people with asthma can have aspirin sensitivity. Asthma is triggered within 1 to 3 hours of ingesting aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). This is known by several terms including aspirin-induced asthma (AIA), aspirin-sensitive asthma, Widal syndrome, aspirin-exacerbated respiratory disease, or Samter triad.

Although the terms refer only to aspirin, asthma patients who are sensitive to aspirin are often sensitive to other NSAIDs such as ibuprofen.

The main purpose of this article is to alert people with asthma about the potential risks of taking Ibuprofen or other NSAIDs. Nonetheless, AIA only affects a minority of asthma patients.

The data on the pervasiveness of AIA in adults with asthma shows a wide variance. Some studies show a prevalence of about 10% among adults with asthma. While in other studies, the prevalence is quoted to be in the range of 2 and 20 per cent.2 

The 3 most important takeaways are:

1. Asthma patients taking Ibuprofen or other NSAIDs for the first time have to be cautious.

2. Consult your GP if you have clinical conditions that suggest an increased risk of AIA.

3. Use alternatives like acetaminophen for pain relief.

Inflammation and the effects of NSAIDs

Inflammation is the body’s immune system response to infection and injury. Therefore, it is typically a beneficial event as it leads to the removal of offending factors and restoring the affected tissue structure and function.

Prostaglandins play a key role in the body’s inflammatory response. Their biosynthesis (a multi-step process by enzymes) increases significantly in the inflamed tissues. Prostaglandins are formed when arachidonic acid (AA) is released and metabolised by the enzyme cyclo-oxygenase (COX). The 2 major enzymes in the COX pathways are:

·         Cyclo-oxygenase 1 (COX-1)

·         Cyclo-oxygenase 2 (COX-2)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are anti-inflammatory medicines that are used to relieve pain, lessen inflammation, and bring down a high temperature. NSAIDs are available in many forms such as tablets, capsules, suppositories, gels, creams, and injections.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

  1. 2-acetyloxy benzoic acid derivatives e.g., aspirin
  2. Propionic acid derivatives e.g., ibuprofen, naproxen, ketoprofen
  3. Acetic acid derivatives e.g., indometacin
  4. Enolic acids derivatives e.g., piroxicam
  5. Diaryl substituted pyrazoles e.g., celecoxib

NSAIDs act as inhibitors of COXs. These anti-inflammatory drugs stop or slow down the enzyme cyclo-oxygenase (COX). Therefore, it stops the formation of prostaglandins from arachidonic acid.

Overview of what is ibuprofen

Ibuprofen is an everyday painkiller for your aches and pains including toothache, period pain, and back pain. It is also used to treat inflammation such as sprains and strains, or pain from arthritis.

You can get ibuprofen in various forms such as tablets, capsules, granules, and as a liquid. It is also available as a gel, mousse, and spray that you rub into your skin.

Overview of what is asthma

Asthma is a common long-term condition that results in coughing, chest tightness, wheezing, and breathlessness.

Asthma symptoms do not appear all the time. Some asthma patients may not have symptoms for weeks or months. Nevertheless, asthma has to be treated daily to lower the risk of symptoms and asthma attacks.

Many people with asthma usually start with childhood asthma, but adults can develop asthma too. There are a lot of things that can make asthma worse and common asthma triggers include

·         Colds and viruses

·         Pets

·         Pollen

·         Pollution

·         House dust mites

·         Stress

Different types of asthma vary in severity. Nonetheless, there is always the risk of an asthma attack for every type of asthma. A severe asthma attack could even result in death. 

How does Ibuprofen affect asthma?

Hypersensitivity to aspirin and other NSAIDs (like Ibuprofen) in people with asthma is due to the pharmacological properties of the drugs.

NSAIDs stop the enzyme COX from working, in particular the inhibition of COX-1. This inhibition causes a lack of protective anti-inflammatory prostaglandins but an excess of pro-inflammatory leukotrienes. 

These leukotrienes are responsible for triggering acute asthma attacks and causing long-term hypersensitivity of the airways in chronic asthma.

AIA patients are susceptible to the negative effects of leukotrienes that result in excessive naso-ocular and asthma reactions.3

What is the risk of taking Ibuprofen if you have asthma?

As mentioned above, the prevalence of AIA among asthma patients is in the region of 2 to 20 per cent. If you have not been exposed to aspirin or other NSAIDs, then you should take these medicines with caution if you have a history of asthma.

However, the following asthma patients are at a greater risk of taking NSAIDs (including Ibuprofen) if they have the following clinical features.2

The main clinical features of asthma patients who have aspirin sensitivity are:

·         Middle age

·         Female

·         Asthma or rhinitis

·         Family history of atopy (to develop allergic diseases)

·         History of nasal polyps (swollen tissue that grows from the sinuses)

The specific clinical features of asthma patients with an increased risk of AIA are:

·         Chronic nasal congestion

·         Profuse rhinorrhoea

·         Nasal polyp

·         Severe asthma attack

·         Adult-onset, non-allergic asthma

Asthma is triggered 1 to 3 hours after consuming NSAIDs (like Ibuprofen). Additional symptoms might include the following:

·         Profuse rhinorrhoea

·         Periorbital oedema

·         Conjunctival infection

·         Flushing of head and neck

·         Vomiting

·         Diarrhoea

Asthma patients may have any or all of the above symptoms. Even so, the reactions may vary from being very mild to severe, constriction of the bronchial tubes. The latter is life-threatening and requires hospital admission.  

Alternative medications to Ibuprofen

If you do need a dose of pain relief, you can use non NSAIDs. 

Acetaminophen (e.g., Tylenol, Paracetamol, Tempra or Excedrin) also reduces your pain and lowers your temperature.4

Unlike NSAIDs, Acetaminophen appears to be safer for people with asthma and less likely to cause gastrointestinal problems. It is also safe for women who are pregnant and nursing.

However, Acetaminophen does not reduce swelling which NSAIDs do. It may also be less useful for treating pain caused by inflammation such as some types of arthritis.

Conclusion

The prevalence of aspirin-induced asthma (AIA) in asthma patients is about 10 to 20 per cent. Furthermore, certain clinical features suggest an increased risk of sensitivity to aspirin and other NSAIDs (like Ibuprofen).

Aspirin or other NSAIDs could induce mild reactions to severe and life-threatening asthma in susceptible patients.

You might also want to check this article: does a humidifier help with asthma.

References

  1. Asthma and Lungs UK [Internet]. London: Asthma and Lung UK; 2021. What is asthma?; 2021[cited 2022 Apr 1]. Available from: asthma.org.uk/advice/understanding-asthma/what-is-asthma/
  2. Specialist Pharmacy Service (NHS England) [Internet]. London: NHS; Can nonsteroidal anti-inflammatory drugs be used in adult patients with asthma?; 2020 Jun 9 [cited 2022 Apr 1]. Available from: https://www.sps.nhs.uk/articles/can-nonsteroidal-anti-inflammatory-drugs-be-used-in-adult-patients-with-asthma/
  3. Berger A. What are leukotrienes and how do they work in asthma. BMJ [Internet]. 1999 Jul 10 [cited 2022 Apr 1]; 319:90. Available from: https://www.bmj.com/content/319/7202/90.1 DOI: 10.1136/bmj.319.7202.90
  4. Webmd. Everyday Pain Relief: Asthma [Internet]; 2009 [cited 2022 Apr 1]. Available from: https://www.webmd.com/asthma/features/everyday-pain-relief-asthma

Author: V Santhirasegaran CFA, FCCA

Master of Arts (MA), Instructional Design & Technology
Nanyang Technological University

Santhirasegaran has 9 years of experience in the private equity industry. As such, he has worked with others to raise capital for seed and start-up investments such as health tech start-ups.

He is passionate about health and fitness. Moreover, he is intrigued by preventive healthcare and longevity studies.

Santhirasegaran is a Chartered Financial Analyst (CFA Charterholder), and a fellow member of the Association of Chartered Certified Accountants (FCCA).

https://www.linkedin.com/in/v-santhirasegaran-72b24921a/

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