What is Aspirin-Induced Asthma?

Link Between Aspirin and Asthma and How to Prevent and Treat this Type of Asthma

Aspirin Tablets. Credit: Nine OK / Getty Images

Most people don't think twice about popping an aspirin when they have a headache. But for some people with asthma, this simple remedy can be fatal.

What is Aspirin-Induced Asthma?

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofennaproxen and diclofenac have been found to trigger asthma attacks in people who have asthma. The asthma attacks induced by aspirin and NSAIDS are often severe and can even be life-threatening.

The aspirin sensitivity appears to increase as people age, and it's worse in people with more severe asthma.

This syndrome has been recognized for many years, but it was unclear how many people with asthma faced a risk when taking these commonly used medications until studies were done on it.

A large 2004 study reviewed the studies done on aspirin-induced asthma (AIA for short). The researchers were surprised to find that 5 percent of children with asthma and 21 percent of adults with asthma were susceptible to AIA.

The results of this study are important because the people involved were actually "challenged" with aspirin in a controlled setting, which made for a particularly accurate estimate of how many people are affected by AIA. This way of conducting the study reduced the likelihood that people would attribute their asthma attack to the illness for which they were taking the aspirin, something the researchers concluded did happen frequently.

In fact, the investigators found that when people were asked to report prior aspirin-induced asthma attacks, the rate of positive responses was only 2.7 percent.

Why Does Aspirin Sometimes Cause Asthma Attacks?

Doctors and researchers initially believed that this phenomenon was an allergic response to aspirin.

However, it's now believed that aspirin causes asthma attacks in some people because the aspirin acts as a deregulator of leukotrienes. Leukotrienes are substances in the body that cause inflammation and many of the symptoms in asthma.

Are There Aspirin Substitutes That Are Safe for People With AIA?

People who have AIA are also at risk for asthmatic reactions to NSAIDS, which are the medications doctors often prescribe for people who are allergic to aspirin. Studies have found that almost all people – that is who have AIA also have a negative reaction to NSAIDS. The likelihood of suffering an asthma attack was greater in people who reacted to even small doses of aspirin.

Patients with AIA were also tested to see how they would respond to acetaminophen (Tylenol), another common aspirin substitute. With this medication, only 7 percent of people with AIA had an asthmatic reaction. Again, those who were most sensitive to aspirin were more likely to react to acetaminophen as well.

Another category of pain-reliever medications, the anti-inflammatory cyclooxygenase-2 (COX-2) inhibitors such as celecoxib (Celebrex), act on a more specific anti-inflammatory pathway than aspirin and NSAIDS.

Because these drugs have a narrower target in the inflammatory pathway, they do not seem to have the same effect on people with asthma.

Although COX-2 inhibitors do not have the adverse affect of inducing asthma attacks such as aspirin and NSAIDS, the COX-2 inhibitory drugs can increase the risk of heart attack and stroke. People who have AIA and who need an anti-inflammatory medication should speak with their doctor about the risks and benefits of celecoxib.

Treatment and Prevention of Aspirin-Induced Asthma

People with AIA tend to develop symptoms within 30 minutes to 2 hours after taking aspirin or NSAIDS, and the resulting difficulty in breathing may last for hours. The treatment is the same as that for any acute asthma attack -- quick relief rescue inhaler, and oxygen and steroids for severe symptoms.

Leukotriene modifiers are another type of asthma medication that may improve symptoms in patients who have aspirin sensitivity. Because these medications stop the actions of leukotrienes, which have been shown to play a big role in AIA, these drugs, along with inhaled steroids, are commonly prescribed to people with AIA. 

The best way to prevent medication-induced asthma attacks is to completely avoid aspirin and NSAIDS. People who have asthma and are not sure if they have reacted to aspirin in the past should ask their doctor if it's safe to test for sensitivity to aspirin and NSAIDS. This should be done only in a controlled setting because of the risk of severe reactions.

People with known aspirin/NSAID sensitivity who need to take aspirin or anti-inflammatory medications for treatment of other conditions, such as heart disease or rheumatic diseases, are recommended to undergo aspirin desensitization. This can be done by a doctor who specializes in allergies and immunology. Once this process has been conducted, it's important that the person continue to take aspirin daily, so he will remain desensitized.


Gyllfors, P., et al. Biochemical and clinical evidence that aspirin-intolerant asthmatic subjects tolerate the cyclooxygenase 2-selective analgetic drug celecoxib. J Allergy Clin Immunol. 2003 May;111(5):1116-21.

Jenkins, C., Costello, J., & Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice." BMJ. 2004 Feb 21;328(7437):434.

Macy, E., et al. Aspirin challenge and desensitization for aspirin-exacerbated respiratory disease: A practice. Ann Allergy Asthma Immunol. 2007 Feb;98(2):172-4.

National Heart Lung and Blood Institute. U.S. Department of Health and Human Services, National Institutes of Health. (August 2007). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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