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The Use of Analgesics in Patients with Asthma

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Abstract

Aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) cause deterioration in respiratory function in approximately 10% of adults with asthma and a smaller proportion of children with asthma.

We propose evidence-based guidelines for the safe use of NSAIDs in individuals with asthma following systematic review of data from the last 10 years relevant to the use of these drugs in such patients.

We would currently recommend that patients with asthma who are known to be intolerant of NSAIDs or who exhibit any of the high risk clinical features for intolerance to these drugs (severe asthma, nasal polyps or chronic rhinosinusitis) should use NSAIDs only under close medical supervision. In those with high risk features formal aspirin provocation testing would be recommended prior to the therapeutic use of NSAIDs. Those individuals with asthma who regularly use NSAIDs can continue to do so but should be warned that intolerance to NSAIDs can develop late in life. Lack of relevant experimental evidence precludes the production of evidence-based guidelines for the group of patients with asthma who do not exhibit high risk clinical features and who have never before used NSAIDs. We would currently recommend that this group be treated as potentially intolerant to NSAIDs and use of these drugs can only be recommended under medical supervision but note that further studies and clinical experience could be expected to relax this restriction for many patients.

Recent data have suggested that frequent use of paracetamol (acetaminophen) may contribute to a deterioration of respiratory function in asthma. A small proportion of patients with asthma who are NSAID-intolerant experience short-lived deterioration in respiratory function with the use of high doses of paracetamol but this is uncommon and has not been implicated in life-threatening reactions. Routine warnings about paracetamol use in asthma are, therefore, not warranted. Medical personnel, however, should be aware of the potential for worsening of symptoms in some individuals with asthma using paracetamol and institute formal investigation or withdrawal of the drug if they suspect such a reaction.

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Acknowledgements

The authors would like to thank Dr Chris Corrigan, Dr John Rees and Dr Mac Cochrane from Guys and St Thomas’ Hospitals for their very helpful comments about this manuscript.

We would also like to thank Helaina Checketts, librarian at the Medical Toxicology Unit, for her contribution to the data collection.

Dr Sarah Levy’s post was part-funded by Boots Healthcare International during the preparation of this article. Dr Glyn Volans has a longstanding interest in the safety of ibuprofen and other nonsteroidal anti-inflammatory drugs and in the past has undertaken limited consultancy work for a number of pharmaceutical manufacturers.

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  1. Medical Toxicology Unit, Guy’s and St Thomas’ NHS Trust and School of Health and Life Sciences, Kings College, Avonley Road, London, SE14 5ER, United Kingdom

    Sarah Levy & Glyn Volans

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  1. Sarah Levy
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Correspondence to Sarah Levy.

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Levy, S., Volans, G. The Use of Analgesics in Patients with Asthma. Drug-Safety 24, 829–841 (2001). https://doi.org/10.2165/00002018-200124110-00004

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