What medications should you avoid with asthma?

October 12, 2025 •

4 min read

Up to 20% of adults with asthma have a sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, which can trigger severe reactions. This highlights the critical importance of knowing what medications should you avoid with asthma? to prevent potentially dangerous flare-ups that can lead to emergency care.

Quick Summary

Certain drugs, including NSAIDs and beta-blockers, can exacerbate asthma symptoms by causing bronchospasm. Understanding these risks is vital for patient safety and effective disease management. This guide covers the major drug classes to be wary of and suggests safer alternatives.

Key Points

NSAIDs can cause severe reactions in some asthmatics: Pain relievers like aspirin, ibuprofen, and naproxen can trigger bronchospasm in individuals with aspirin-exacerbated respiratory disease (AERD).
Avoid non-selective beta-blockers: These are used for heart conditions but block beta-2 receptors in the lungs, which can cause airways to constrict and trigger an attack.
Discuss ACE inhibitors if you develop a cough: This class of blood pressure medication can cause a persistent dry cough that can be confused with or worsen asthma symptoms.
Be cautious with sulfite-containing products: Found in many foods and some medications, sulfites can cause allergic-like reactions and trigger bronchospasm in susceptible people with asthma.
Communicate with your doctor before new medication: Informing your healthcare providers about your asthma is critical before starting any new drug, including eye drops or contrast dyes.
Know your safe pain relief alternative: Acetaminophen (Tylenol®) is generally considered a safe pain and fever reducer for people with aspirin-sensitive asthma.

For individuals managing asthma, controlling triggers is a critical part of a treatment plan. While many triggers are environmental, some are related to medications commonly used for other conditions. Certain drug classes can cause the airways to tighten, leading to wheezing, coughing, and shortness of breath. Knowing which medications to avoid is essential for preventing dangerous asthma attacks.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

For a significant portion of the asthma population, particularly adults, aspirin and other NSAIDs can pose a serious risk.

Mechanism: In sensitive individuals, NSAIDs block the cyclooxygenase (COX-1) enzyme. This shifts the body's metabolic pathway, leading to an overproduction of leukotrienes, which are potent inflammatory mediators. This causes bronchoconstriction, or the tightening of the airways.
Risk Factors: The sensitivity to NSAIDs is a condition known as Aspirin-Exacerbated Respiratory Disease (AERD), which is often associated with nasal polyps. This combination of asthma, aspirin sensitivity, and nasal polyps is sometimes called Samter's triad. An individual might suddenly develop this sensitivity later in life, even if they have tolerated NSAIDs previously.
Common NSAIDs to Avoid:
- Aspirin (including low-dose varieties like Ascriptin® and Bufferin®)
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Ketoprofen
- Diclofenac (Voltaren®)
Safer Alternative for Pain Relief: For most people with asthma, acetaminophen (Tylenol®) is a safe alternative.

Beta-Blockers

Prescribed for a range of conditions including high blood pressure, heart disease, and migraines, beta-blockers can cause significant respiratory issues for people with asthma.

Mechanism: Beta-blockers interfere with the body's natural adrenaline response by blocking beta-adrenergic receptors. While some are selective for the heart's beta-1 receptors, non-selective beta-blockers block both beta-1 and beta-2 receptors. The beta-2 receptors are located in the bronchial smooth muscles of the lungs, and blocking them can trigger severe bronchospasm.
Types of Beta-Blockers:
- Non-Selective Beta-Blockers: Should be strictly avoided by most people with asthma due to the high risk of triggering an attack. Examples include propranolol (Inderal®) and timolol (in oral and eye drop forms).
- Cardioselective (Beta-1 Selective) Beta-Blockers: While considered safer, selectivity can be lost at higher doses, potentially affecting the lungs. They should only be used under a doctor's close supervision, and the benefits must outweigh the risks. Examples include metoprolol and atenolol.
Eye Drops: Beta-blocker eye drops, often prescribed for glaucoma, can be absorbed systemically and trigger an asthma attack. Examples include timolol eye drops.

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are a common class of medication for treating hypertension and heart failure. While they don't directly cause bronchospasm like beta-blockers, they can induce a persistent, dry cough that can complicate or exacerbate asthma symptoms.

Mechanism: The cough is a common side effect, affecting up to 10% of patients. It is thought to be caused by the accumulation of bradykinin, a substance that can irritate the airways. This cough can be difficult to distinguish from an asthma cough and may worsen airway hyperresponsiveness.
Examples: Common ACE inhibitors that can cause this issue include lisinopril (Zestril®) and enalapril (Vasotec®).
Alternative: Angiotensin II Receptor Blockers (ARBs), such as losartan, are a suitable alternative for many people as they do not typically cause the same cough side effect.

Other Medications and Substances

In addition to the major drug classes, other substances can also act as triggers for some individuals with asthma:

Sulfites: These are preservatives found in some foods (e.g., dried fruits, wine, beer) and medications that can trigger bronchospasm, particularly in people with asthma.
Contrast Dyes: Some patients with asthma may have a higher risk of adverse reactions, including bronchospasm, to contrast dyes used during certain medical imaging procedures. It is crucial to inform your medical team that you have asthma before undergoing such tests.
Recreational Drugs: Inhaling substances like marijuana, crack cocaine, or heroin can directly irritate the airways and worsen asthma. Opioids can also cause histamine release, which can trigger symptoms.
Herbal and Complementary Products: It's important to discuss any over-the-counter or herbal remedies with a doctor, as some may contain ingredients or trigger allergic reactions that can affect asthma.

Comparison of Common Asthma-Exacerbating Medications


Drug Class	Effect on Asthma	Mechanism	Safe Alternatives	Action Required
NSAIDs	Can trigger severe bronchospasm in sensitive individuals (AERD).	Inhibits COX-1 enzyme, leading to overproduction of inflammatory leukotrienes.	Acetaminophen (Tylenol®).	Avoid if sensitive or if AERD is suspected; inform all healthcare providers.
Beta-Blockers	Non-selective types can cause severe bronchospasm.	Blocks beta-2 adrenergic receptors in the lungs.	Cardioselective types (use with caution), ARBs, or other non-beta-blocker antihypertensives.	Avoid non-selective types; use cardioselective types only under specialist supervision.
ACE Inhibitors	Can cause a persistent, dry cough that mimics or worsens asthma.	Accumulation of bradykinin, a respiratory irritant.	Angiotensin II Receptor Blockers (ARBs) like losartan.	Inform doctor if cough develops; may need to switch medication.
Sulfites	May trigger bronchospasm in sensitive individuals.	Release sulfur dioxide gas that can irritate airways.	Avoid foods and drinks with high sulfite content.	Check food and medication labels carefully.
Contrast Dyes	Higher risk of bronchospasm in people with asthma.	Potential non-allergic reactions or direct irritation.	None, but pre-treatment with corticosteroids/antihistamines may reduce risk.	Inform medical team of your asthma before imaging procedures.

Conclusion

For those with asthma, vigilance regarding medication is paramount. Many drugs, even seemingly harmless over-the-counter options like NSAIDs, can trigger serious respiratory symptoms in susceptible individuals. Non-selective beta-blockers and ACE inhibitors also present clear risks, whether through direct bronchospasm or by inducing a complicating cough. It is essential to maintain open communication with all healthcare providers about your asthma status before starting any new prescription or over-the-counter medication. Always discuss potential drug interactions and safer alternatives, such as acetaminophen for pain and ARBs for hypertension, to ensure your treatment plan prioritizes both your overall health and respiratory safety.

For more information and resources on asthma triggers and management, please consult the American Academy of Allergy, Asthma & Immunology (AAAAI) website: https://www.aaaai.org.

Frequently Asked Questions

If you have asthma, you should be very cautious with NSAIDs like ibuprofen and aspirin. A significant percentage of adults with asthma have a sensitivity that can cause severe and sometimes fatal attacks. It is best to avoid these unless a doctor confirms they are safe for you. A safer alternative for most is acetaminophen.

No, not all beta-blockers are equally unsafe. Non-selective beta-blockers, which affect receptors in the lungs, should be avoided as they can trigger bronchospasm. Cardioselective beta-blockers are safer but should only be used under a doctor's supervision, as their selectivity can decrease at higher doses.

Yes, the persistent dry cough caused by ACE inhibitors can easily be confused with or may trigger worsening asthma symptoms. It is important to tell your doctor if you develop a cough while taking an ACE inhibitor, as switching to an alternative medication like an ARB can resolve the issue.

Yes, beta-blocker eye drops used for conditions like glaucoma can be absorbed into the bloodstream and affect the lungs. This can cause bronchospasm and should be discussed with your doctor if you have asthma.

For most people with asthma, acetaminophen (Tylenol®) is a safe alternative to NSAIDs for pain and fever relief. Reactions to acetaminophen are very rare in asthmatics, but it is always wise to monitor your symptoms after taking any new medication.

AERD is a condition characterized by asthma, aspirin and NSAID sensitivity, and often nasal polyps. In individuals with AERD, NSAID ingestion can cause severe respiratory reactions, including life-threatening asthma attacks. Total avoidance of COX-1 inhibiting NSAIDs is recommended for people with this condition.

Yes, you should always inform your medical team that you have asthma before undergoing any procedure involving contrast dye. People with asthma have a higher risk of adverse reactions, including bronchospasm, to these dyes, though pre-treatment can often reduce the risk.