Ibuprofen and Asthma

Introduction

Asthma is a chronic condition that affects the lungs and is prevalent in all ages. Symptoms include:

• Breathing difficulties
• Wheezing
• Coughing

These symptoms can occasionally get worse, and people with asthma may experience a sudden drastic increase in symptoms. This is called an asthma attack, which can be life-threatening if not treated promptly. 

Asthma is very common in the UK, where it affects about 1 in 12 adults and 1 in 11 children.¹

Ibuprofen is one of the most common drugs that is used for treating pain and is widely available for purchase from pharmacies. However, this medication doesn’t come without side effects. Ibuprofen has the potential to exacerbate or induce an asthma attack in those with asthma.² 

Effects of ibuprofen on asthma

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, fever, and inflammation. It is also known as brands such as brufen, calprofen, cuprofen, and nurofen, among others.² 

Ibuprofen and other NSAIDs work by blocking an enzyme called cyclo-oxygenase (COX) that produces prostaglandins. Prostaglandins are produced when there is an injury and leads to inflammation. By reducing the production of prostaglandins, ibuprofen reduces inflammation and pain.³ 

There are two types of COX enzymes, COX-1 and COX-2. COX-1 tends to be involved in the gastrointestinal tract, in platelet formation, and macrophage differentiation; COX-2 is mostly involved in inflammation.³ 

NSAIDs including aspirin can, however, trigger an asthma attack in those with asthma.^2.3  

Risks of taking ibuprofen if you have asthma

There are some factors that increase the risk of asthma patients having an asthma attack after taking ibuprofen, which include: 

• Being female 
• Having severe asthma with chronic nasal congestion 
• History of nasal polyps 

It is important to note that about 80-90% of adults with asthma will be able to take NSAIDs. The range of reactions that develop can range from mild to life threatening. 

The reactions that occur with NSAIDs tend to be dose dependent, where small doses may not cause a significant reaction. Increases in dosage can result in a more severe reaction. Although, in some instances, even low dose aspirin (75mg) can trigger an asthma attack.⁴ 

Who can and can’t take ibuprofen 

Ibuprofen can be used from 3 months old in the form of a liquid. Most people tend to tolerate ibuprofen, although it is not suitable for everyone. For example those who;

• have had an allergic reaction to ibuprofen or other NSAIDs (there is cross sensitivity among NSAIDs) 
• Have asthma, as there is a potential for exacerbation
• Have kidney problems. as ibuprofen and other NSAIDs reduce blood flow to the kidneys, they can potentially cause acute kidney injury
• Have stomach ulcers, as ibuprofen can lead to gastro-intestinal ulceration
• Have Inflammatory bowel disease such as crohn's disease or ulcerative colitis 
• Have severe heart failure²

Alternatives

Alternatives to NSAIDs for people sensitive to these medications are acetaminophen (paracetamol) to control pain and reduce fever. Acetaminophen has no negative effect on asthma and is generally safe for those with asthma. Acetaminophen does not reduce inflammation, however, so ibuprofen is superior in this case. 

Desensitisation to NSAIDs can occur when there is a gradual increase in the doseage. This is obviously not an ideal route for patients who only take NSAIDs short-term and is mostly considered in patients that require NSAIDs for long term use, who need them on a regular basis at a high dose.^4,5 

There is some evidence that the use of COX-2 selective inhibitors (such as celecoxib,and etoricoxib) can help those with asthma who are susceptible to aspirin-induced asthma. It is important to note that, currently, the use of COX-2 selective inhibitors is contraindicated based on the manufacturers summary of product characteristics; however, they are being used outside their product license based on specialist advice.⁴

The use of ice packs for injuries such as sprained ankles can reduce swelling and pain. 

A heat pad can be used to reduce pain in patients who experience chronic pain, such as back pain. However, they should not be used in acute injuries as heat can initially make the swelling and pain worse.⁶ 

When to seek medical advice

In rare cases where ibuprofen or other NSAIDs have caused:

• Severe breathing problems,
• Wheezing, 
• Swollen skin (that itches) 
• Swollen face, mouth, lips 

Immediate medical attention should be sought as this is life threatening ⁽⁷⁾. 

Summary

Ibuprofen alongside other NSAIDs are used widely and are generally safe, however they are not safe for everyone, specially in certain patients with asthma. Therefore, precautions are needed to ensure alternative pain treatments are available to those who can't take NSAIDs.