Do You Have Asthma? Here Are Classes of Drugs You May Need to Avoid
Key takeaways:
Many things can worsen asthma symptoms and trigger asthma attacks. These include medications and irritants in the air.
Nonselective beta blockers and nonsteroidal anti-inflammatory drugs (NSAIDs) are two classes of drugs that can make asthma symptoms worse for some people.
People with asthma may need to avoid these medications and use alternative options to treat high blood pressure and pain.
Asthma is a condition that affects the lung’s airways. It’s episodic, which means that people with asthma usually breathe normally. But sometimes they have symptoms like wheezing, chest tightness, or shortness of breath.
Allergies, physical activity, and irritants in the air like smoke or perfumes can all trigger asthma symptoms. Some classes of drugs may also trigger these symptoms. If you have asthma, here are medications you may need to avoid to help keep your asthma under control.
Can medications trigger an asthma attack?
Yes, some medications can trigger asthma symptoms.
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When someone has asthma, the airways in the lungs “overreact” when exposed to certain things. The airways tighten and become more narrow, which makes it harder for air to move in and out of the lungs. Think of trying to blow air through a thin straw. This narrowing causes symptoms like wheezing, cough, chest tightness, and shortness of breath.
Things that can trigger the airways include pet dander, dust, and smoke. But some medications can also irritate the airways and trigger asthma attacks. Two drug classes that may make asthma symptoms worse for some people are nonselective beta blockers and nonsteroidal anti-inflammatory drugs (NSAIDs).
Beta blockers
Beta blockers are a class of medication that treat high blood pressure and other heart problems. They work by blocking beta receptors inside the heart and blood vessels. This slows your heart rate and lowers your blood pressure.
There are two categories of beta blockers: selective and nonselective.
Selective beta blockers target the beta receptors in the heart and blood vessels. They don’t affect other parts of the body. Some selective beta blockers include:
Nonselective beta blockers act on beta receptors throughout the body, including the lungs. Examples of nonselective beta blockers are:
Selective beta blockers are safe for people with mild or moderate asthma. But people with asthma may need to avoid certain nonselective beta blockers. That’s because when beta receptors in the lungs are blocked, the airways can become tight and trigger an asthma attack.
Recent studies show that not all nonselective beta blockers worsen asthma symptoms. But this may vary from person to person. People with asthma should talk to their healthcare providers about whether nonselective beta blockers are right for them.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are medications that ease inflammation and pain. Some NSAIDs need a prescription, but many are available over the counter. Common NSAIDs include:
Most people with asthma can take NSAIDs without triggering their asthma symptoms. But about 1 in 5 of people with asthma become sensitive to NSAIDs over time. These people can develop asthma-exacerbated respiratory disease (AERD). People with AERD may experience worsening asthma symptoms if they take an NSAID.
You don’t always need to avoid NSAIDs just because you have asthma. But if you think your asthma gets worse when you take NSAIDS, talk to your healthcare provider. You can get tested to see if you have AERD.
If you have AERD, you may be able to take acetaminophen (Tylenol) as an alternative pain medication. Acetaminophen doesn’t affect the airways and won’t lead to AERD.
If you can’t take acetaminophen and have AERD, you still have options. You can try aspirin desensitization therapy. This involves taking a very small dose of NSAIDs and gradually working your way up to higher doses. And this process helps you rely on NSAIDs without triggering your asthma symptoms.
Which other medications can affect the lungs?
Even in people who don’t have a history of asthma, several other medications can affect the lungs:
Chemotherapy medications: Some cancer treatments, like bleomycin and gemcitabine, may lead to lung injury.
Disease-modifying antirheumatic drugs (DMARDs): These medications act on the immune system to help treat diseases like rheumatoid arthritis and psoriatic arthritis. Some DMARDs, like methotrexate and leflunomide, may sometimes lead to lung injury.
ACE inhibitors: These medications, like lisinopril and enalapril, treat high blood pressure and lower the risk of heart and kidney disease. Some people taking ACE inhibitors develop a dry cough. The cough isn’t dangerous. But sometimes, it gets confused with asthma. If you’re taking an ACE inhibitor, remember that your medication won’t damage your lungs or trigger your asthma. You may need to switch medications, but once you do, the cough will go away.
What to do if you’re taking beta blockers or NSAIDs and have asthma
If you have asthma and are taking a beta blocker or NSAID, talk to your healthcare provider. You may be able to switch to another class of medication that won’t trigger your asthma. If you’ve noticed that your asthma symptoms are getting worse, it’s best to see your provider as soon as possible. But don’t stop taking your medications until you’ve talked to your healthcare provider. Stopping medication suddenly can make your condition worse.
Should you take blood pressure medication if you have asthma?
Yes, you should take blood pressure medication if you have asthma.
Keeping your blood pressure under control protects your heart. While non selective beta blockers may not be the right medication for you, there are plenty of other safe options, like:
Selective beta blockers
The bottom line
If you have asthma, it’s important to know that some drug classes can worsen asthma symptoms for some people. Nonselective beta blockers and NSAIDs are two groups of medications that can sometimes worsen asthma symptoms. If you have asthma and are taking these classes of drugs and have worsening asthma symptoms, talk to your healthcare provider about whether you should switch to another medication that won’t trigger your asthma.
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References
American Academy of Allergy, Asthma & Immunology. (2018). Saving time for AERD patients during aspirin challenge and desensitization.
Herman, L. L., et al. (2022). Angiotensin converting enzyme inhibitors (ACEI). StatPearls.
Levy, S., et al. (2012). The use of analgesics in patients with asthma. Drug Safety.
McCarty, J. C., et al. (2013). Identifying asthma triggers. Otolaryngologic Clinics of North America.
Padda, I. S., et al. (2022). Leflunomide. StatPearls.
Salpeter, S. R., et al. (2002). Cardioselective beta-blockers for reversible airway disease. The Cochrane Database Systematic Review.
Skeoch, S., et al. (2018). Drug-induced interstitial lung disease: A systematic review. Journal of Clinical Medicine.
Tiotiu, A., et al. (2019). Beta-blockers in asthma: Myth and reality. Expert Review of Respiratory Medicine.
