Medications That Can Worsen Asthma

When we think of triggers for asthma, the use of medicines for other medical problems doesn’t usually come to mind. Usually, medicines help a person’s medical conditions—doesn’t worsen them. However, there are some medicines that a person can take that can worsen asthma symptoms, or cause other respiratory symptoms such as coughing. Therefore, it is important that you inform each and every doctor that treats you about your asthma and other medical problems.

Woman looking at medication in a store
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Beta-blockers are commonly used medicines for the treatment of high blood pressure, heart arrhythmias and for the prevention of migraine headaches. They are also used in eye-drop form for the treatment of glaucoma.

Beta-blockers act on certain receptors present on different organs throughout the body resulting in decreased heart rate, blood pressure, and “pump function” of the heart. Unfortunately, some beta-blockers have the opposite effect on the lung that albuterol does, and can result in constriction of the muscles around the airways. This has even been reported with the use of eye drops containing the beta-blocker timolol.

While newer beta-blockers are only supposed to act on the heart (termed “cardioselective”), older beta-blockers—such as timolol, propranolol, or labetalol—are known to worsen asthma symptoms. In some cases, a person with asthma has a dire need for a beta-blocker. If this is the case, the person should ask their doctor for a cardioselective beta-blocker. If asthma symptoms are still worsened, an inhaled medication with anticholinergic effects, such as ipratropium (Atrovent HFA) or tiotropium (Spiriva), may be helpful to counteract this problem.

Aspirin and Aspirin-Like Medications

Aspirin and related medicines, termed non-steroidal anti-inflammatory medicines (NSAIDs), are commonly used medicines for the treatment of joint and muscle pain and inflammation, headaches, fever, as well as antiplatelet drugs for the prevention of heart attacks and strokes. Commonly used NSAIDs that are available over the counter (OTC) include ibuprofen (e.g., Advil and Motrin), and naproxen (e.g., Naprosyn and Aleve).

Some people have allergic reactions to NSAIDs, which can result in worsening of allergy and asthma symptoms, or urticaria/angioedema or even anaphylaxis. Approximately 7%–14% of people with asthma can experience worsening asthma symptoms as a result of taking NSAIDs, depending on the severity of their asthma.

When an alternative pain medicine to NSAIDs is needed, many people with NSAID reactions can tolerate acetaminophen (Tylenol), another pain medicine, which isn’t an NSAID.

Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)

ACE inhibitors are commonly used medicines for the treatment of high blood pressure and heart failure. Common generic-brand forms include lisinopril, ramipril, and many other forms ending in the letters “pril.” Some people have respiratory side effects from this class of medicine, with approximately 10% having a nagging, dry cough

This cough can be mistaken for worsening asthma or other common causes of a cough. Generally, the cough will go away within a few weeks of stopping the ACE inhibitor.

Angiotesin II receptor blockers (also known as ARBs) have similar therapeutic value to ACE-inhibitors and can often be used as a substitute for ACE-inhibitors. They are much less likely to cause a cough than ACE-inhibitors. In cases where an ACE-inhibitor cannot be stopped or substituted with an ARB, inhaled cromolyn (previously marketed as Intal) may be useful to treat an ACE inhibitor-induced cough.

4 Sources
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By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.