Everyday Pain Relief: Asthma

Many common over-the-counter pain relief drugs can cause harmful side effects, such as breathing problems, for those with asthma. Here's what you need to know.

By R. Morgan Griffin
WebMD Feature

Reviewed By Charlotte Grayson

If you have asthma, you most likely work hard to avoid triggers. You shut the windows when the air is thick with pollen. You steer clear of homes with pets. You banish smokers to your front porch.

But did you know that a potentially serious asthma trigger might be sitting in your medicine cabinet right now?

The culprit is aspirin, that trusted wonder drug, along with other common over-the-counter (OTC) painkillers. These are medicines we use without thinking twice. But in one in five people with asthma, these drugs can make symptoms worsen. They can even cause dangerous or even fatal reactions.

"It happens a lot more than people realize," says Phillip E. Korenblat, MD, spokesman for the American Academy of Allergy, Asthma, and Immunology. "If you went to any ER right now, you'd be likely to see people with asthma who were there because of a bad reaction to these drugs."

The problem doesn't end with OTC painkillers. In fact, many remedies for colds, sinus problems, and even indigestion contain the same potentially dangerous ingredients.

So before you grab a bottle of pain reliever for that headache, you need to learn some dos and don'ts.

How Do Pain-Relief Drugs Work?

In a certain way, all pain is in your head. When we feel pain, it's the result of an electrical signal being sent from the nerves in a part of your body to your brain.

But the whole process isn't electrical. When tissue is injured (by a sprained ankle, for instance), the cells release certain chemicals. These chemicals cause inflammation and amplify the electrical signal coming from the nerves. As a result, they increase the pain you feel.

Painkillers work by blocking the effects of these pain chemicals. The problem is that you can't focus most pain relievers specifically on your headache or bad back. Instead, it travels through your whole body. This can cause some unexpected side effects.

What Are the Risks for People with Asthma?

If you have asthma, painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) can be risky. They include aspirin, ibuprofen, naproxen, and ketoprofen, the active ingredients in medicines like Bufferin, Advil, and Aleve.

Other pain relievers are potentially less dangerous. Acetaminophen -- the active ingredient in Tylenol -- works differently. It poses a much lower risk of problems for people with asthma, although like any drug, it does have side effects of its own. You shouldn't take any over-the-counter painkiller for more than 10 days without your health care provider's approval.

Why are people with asthma at special risk from NSAIDs? Experts aren't sure of the exact cause, but it seems that these medicines can trigger a dangerous immune response. People who are older and who have more severe asthma may be more sensitive to these drugs.

Symptoms include a cough, runny nose, shortness of breath, and wheezing. In some people, these medicines can also cause swelling of the face or hives. If you have any reaction, get help right away.

"One problem is that people may not realize the connection between asthma and a painkiller," Korenblat tells WebMD. "It can take up to two hours for the medicine to cause the effect, so you may not see the link."

In general, it's best for people with asthma to avoid NSAIDs. And people with asthma who also have sinus problems or nasal polyps -- swollen tissue that grows from the sinuses into the nasal passages -- should not use any NSAIDs, says Korenblat. "The risks of using these medicines are much higher for them."

Asthma treatments may help. Korenblat says the asthma medicines Singulair and Accolate may partially protect people from bad reactions to NSAIDs. Some doctors "desensitize" people to NSAIDs by giving them small doses and gradually increasing them over time. Eventually, your body may be better able to tolerate the NSAID and won't have such a dangerous reaction. However, this process must be done in a medical setting, since even tiny amounts of these drugs can trigger a dangerous asthma attack.

So what's a person with asthma and an aching back to do? "I tell my patients with asthma that if they have a choice, they should take acetaminophen, such as Tylenol," says Korenblat. "If they have to take an NSAID, I just tell them to be careful and watch for problems."

Other Options for Pain Relief

Of course, painkillers aren't the only answer for many of life's aches and pains. Many effective and safe alternatives don't have any side effects at all.

• Ice packs, for acute injuries like a sprained ankle, can keep down swelling and ease pain.
• Heat -- with a hot towel or heating pad -- can be helpful for treating chronic overuse injuries. (However, you shouldn't use heat on recent injuries.)
• Physical activity can help reduce some kinds of discomfort, such as arthritis pain.
• Relaxation -- with techniques like yoga or meditation -- may reduce pain. Biofeedback may help as well. These approaches are best for pain that's made worse by stress, like tension headaches.
• Nontraditional techniques with low risks -- like acupuncture -- benefit some people.

So remember: Pain relief doesn't only come from a pill bottle.

The Pros and Cons of Pain-Relief Drugs

For those times when you do need a dose of pain relief, you need to make a smart choice. Here's a rundown of the benefits and risks of some popular pain medications. It should help simplify your choices the next time you're in the drugstore.

Keep in mind that you shouldn't use any over-the-counter painkiller on a regular basis. If you're in that much pain, you need to talk with your health care provider.

SLIDESHOW

What is Asthma? Asthma Myths Debunked See Slideshow

ACETAMINOPHEN
Tylenol, Panadol, Tempra (and also an ingredient in Excedrin)

• How it works. Acetaminophen is not an NSAID. Experts aren't actually sure how it works, but it seems to affect chemicals that increase the feeling of pain.
  
  
• Benefits. Acetaminophen reduces pain and lowers fevers. Unlike aspirin and other NSAIDS, acetaminophen seems to be safer for people with asthma.
  
  Acetaminophen is also less likely to cause gastrointestinal problems than NSAIDs. It is safe for women who are pregnant and nursing.
  
  
• Side effects and risks. Experts generally believe that acetaminophen -- taken occasionally and as prescribed -- is safe for people with asthma. However, some recent studies have shown a possible connection between regular use of acetaminophen and an increased risk and worsening of asthma. Since the evidence isn't clear, you should ask your health care provider for advice.
  
  Very high doses of acetaminophen can cause liver damage. Long-term use of acetaminophen in high doses -- especially when combined with caffeine (Excedrin) or codeine (Tylenol with Codeine) can cause kidney disease.
  
  Acetaminophen doesn't reduce swelling, which aspirin and other NSAIDs do. It may be less helpful in treating pain that's caused by inflammation, such as some types of arthritis.

ASPIRIN
Bayer, Bufferin, Ecotrin (and also an ingredient in Excedrin)

• How it works. Aspirin is an NSAID that circulates through your bloodstream. It blocks the effects of chemicals that increase the feeling of pain.
  
  
• Benefits. Aspirin has earned its reputation as a "wonder drug." It eases pain and lowers fevers. It can also reduce inflammation, which means that it can treat the symptom (pain) and sometimes the cause (swelling.)
  
  Aspirin also lowers the risk of blood clots, heart attacks, and strokes, particularly in people at high risk of these problems. Usually, only very low daily doses -- 81 milligrams, or one baby aspirin -- are recommended for cardiovascular protection. Other NSAIDs (like ibuprofen, ketoprofen, or naproxen) and acetaminophen do not have this effect. However, you should never start taking aspirin daily without talking with your health care provider first.
  
  
• Side effects and risks. Aspirin can cause serious reactions in up to 20% of people with asthma. Symptoms include coughing and wheezing. If you have a reaction, get medical care right away. Afterward, do not use aspirin -- or any other NSAID -- without your doctor's permission. Some people may also develop hives and facial swelling.
  
  Aspirin can cause heartburn, upset stomach, pain, or ulcers even in very low doses. Aspirin can be dangerous for people with liver disease, gout, juvenile arthritis, or rheumatic fever. Rarely, aspirin can cause ringing in the ears and hearing loss.
  
  Pregnant women shouldn't use aspirin since it can harm the mother and cause birth defects. Unless your health care provider says it's OK, children and teenagers should not take aspirin because it puts them at risk of Reye's syndrome.
  
  While inflammation can cause pain, it's often a key part of the body's natural healing process. Since this medicine at high doses can prevent inflammation, it can also slow down recovery after certain injuries.

IBUPROFEN
Advil, Motrin IB, Nuprin

• How it works. Like all NSAIDs, ibuprofen blocks the effects of chemicals that increase the feeling of pain.
  
  
• Benefits. Ibuprofen can lower fevers, ease pain, and reduce inflammation.
  
  
• Side effects and risks. People with asthma should not use ibuprofen if they have an alternative. In one out of five people with asthma, it can cause worsening symptoms, which may need immediate treatment. If you have a bad reaction to ibuprofen, you should not use it or any other NSAID without your doctor's permission. Some people may develop hives and facial swelling.
  
  Ibuprofen can cause heartburn, upset stomach, pain, and ulcers. It may also increase the risk of heart attacks and strokes. The FDA requires drug companies to highlight ibuprofen's potential risks. This drug isn't safe during the last three months of pregnancy.
  
  In some cases, ibuprofen can slow down the body's natural healing process.

KETOPROFEN
Actron, Orudis KT

• How it works. Ketoprofen blocks the effects of chemicals that increase the feeling of pain.
  
  
• Benefits. Ketoprofen can lower fevers, ease pain, and reduce inflammation.
  
  
• Side effects and risks. People with asthma should not use ketoprofen if they have an alternative. In one in five people with asthma, it can cause worsening symptoms, which may need immediate treatment. If you have a bad reaction to ketoprofen or any other NSAID, you shouldn't use any without your doctor's permission. Some people may develop hives and facial swelling.
  
  Ketoprofen can cause heartburn, upset stomach, pain, and ulcers. It may also increase the risk of heart attacks and strokes. The FDA requires drug companies to highlight these risks. This drug isn't safe during the last three months of pregnancy.
  
  In some cases, ketoprofen can slow down the body's natural healing process.

NAPROXEN
Aleve

• How it works. Naproxen blocks the effects of chemicals that increase the feeling of pain.
  
  
• Benefits. Naproxen can lower fevers, ease pain, and reduce inflammation.
  
  
• Side effects and risks. People with asthma should not use naproxen if they have an alternative. In one in five people with asthma, it can cause worsening symptoms, which may need immediate treatment. If you have a bad reaction to naproxen or any other NSAID, you shouldn't use them without your doctor's permission. Some people may develop hives and facial swelling.
  
  A recent study seems to show a link between naproxen and an increased risk of heart attack or stroke. More research needs to be done before doctors know for sure. For now, ask your health care provider for advice.
  
  Naproxen can cause heartburn, upset stomach, pain, or ulcers. The FDA requires drug companies to highlight its risks. This drug isn't safe during the last three months of pregnancy.
  
  Naproxen can also slow down the body's natural healing process.

PRESCRIPTION PAINKILLERS

Many painkillers -- including higher doses of NSAIDs -- are available by prescription. Since they are more powerful versions of over-the-counter NSAIDs, they often have the same or greater risks. Some examples are Daypro, Indocin, Lodine, Naprosyn, Relafen, and Voltaren.

Cox-2 inhibitors are a newer kind of NSAID. These medicines have recently come under fire for their dangers. Although these drugs are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. They may also raise the risks of heart attacks and strokes.

Two of these drugs, Vioxx and Bextra, have been taken off the market because of various side effects. Celebrex is still available.

Narcotics are another type of prescription painkiller. Examples include OxyContin, Percocet, and Vicodin. These drugs are only used in people with severe chronic pain. They don't pose a risk for people with asthma. They do have other side effects, including constipation, fatigue, and a risk of addiction.

Published May 2005.

SOURCES: Phillip E. Korenblat, MD, spokesman, American Academy of Allergy, Asthma, and Immunology; professor of clinical medicine, Washington University School of Medicine, St. Louis. Byron Cryer, MD, spokesman, American Gastroenterological Association; associate professor of medicine, University of Texas Southwestern Medical School, Dallas. Nieca Goldberg, MD, spokesperson for the American Heart Association; chief of Women's Cardiac Care, Lennox Hill Hospital, New York. American Academy of Family Physicians. American Heart Association. American Academy of Allergy, Asthma, and Immunology. American Gastroenterological Association. FDA. U.S. Department of Health and Human Services National Women's Health Information Center.

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