Aspirin-induced asthma (AIA) is a condition where asthma symptoms can develop after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). It’s also known as aspirin-exacerbated respiratory disease (AERD) or Samter’s Triad.
The American Academy of Allergy, Asthma, and Immunology (AAAAI) estimates that 9 percent of adults have asthma and that 30 percent of adults who have asthma and nasal polyps may also have AERD.
Read on to learn more about the underlying causes and risk factors of AIA as well as how this condition may be treated.
Acetylsalicylic acid (aspirin) is a type of NSAID used to relieve pain, inflammation, and fever. Similar medications include ibuprofen (Advil) and naproxen (Aleve).
Aspirin and other NSAIDs interact with an enzyme known as cyclooxygenase-1 (COX-1). While the exact triggers are unknown, it’s thought that people with AIA have a sensitivity to the way these medications inhibit this enzyme.
You may be more prone to AIA if you have all three of these conditions:
A doctor may still recommend aspirin for the treatment of other conditions, such as preventing heart attacks or strokes, in cases where a person may have already experienced one of these conditions — and when the benefits outweigh the risks of triggering asthma symptoms.
Symptoms of AIA tend to develop shortly after taking aspirin or other NSAIDs — often within minutes or hours after exposure.
While it’s important to address any suspected symptoms of AIA with a doctor, here’s a breakdown of mild symptoms as well as more severe symptoms that require immediate medical attention.
Mild AIA symptoms
Mild symptoms of AIA may include:
- sinus/nasal congestion
- sinus pain
- mild wheezing
- skin flushing
More severe symptoms of AIA can make it harder to breathe even if you take a rescue inhaler. Although rare, these acute symptoms can be life threatening.
Seek emergency medical help if you experience the following:
- persistent cough
- severe wheezing
- labored breathing
- chest pain/tightness
- abdominal pain
- loss of consciousness
People who develop AIA are usually between ages 20 and 50 years old and likely have a combination of:
- chronic sinusitis
- sensitivity to NSAIDs
You may also be more susceptible if you experience the following on a recurring basis:
- recurring nasal congestion
- sinus infections
Age is another consideration. You more generally can become more vulnerable to side effects from NSAIDs as you age past your 50s.
It’s also possible that reactions to aspirin could be induced by drug allergies. Besides NSAIDs, other common drug allergies include:
- sulfa-containing antibiotics
Symptoms of AIA may also be further exacerbated if you also drink alcohol. The AAAAI estimates that 75 percent of people with the condition may experience symptoms after drinking alcohol along with aspirin use.
AIA is typically diagnosed with the help of an asthma specialist, such as an allergist, pulmonologist, or immunologist.
There’s not just one test that can diagnose AIA. Instead, a diagnosis is made with a combination of the following factors:
- blood testing that can detect elevated eosinophils indicate inflammation
- physical tests to detect the presence of nasal polyps and determine their size
- a thorough medical history to evaluate previous medications, respiratory tract infections, and hospitalizations
- self-reported data, such as a personal health journal, that can indicate asthma exacerbations after taking aspirin
A doctor may also recommend ordering a test called an aspirin challenge to rule out drug allergies. This involves taking aspirin either in the doctor’s office or at the hospital while under medical supervision. Any reactions you have to taking aspirin can then be identified and treated.
Along with avoiding NSAIDs, treatment for AIA involves managing symptoms of asthma, sinusitis, and nasal polyps.
You can also talk with a doctor about the following options.
Home treatments can include:
- complete avoidance of aspirin, aspirin-containing products, and NSAIDs
- taking acetaminophen for occasional pain instead, or as directed by a doctor
- avoiding other allergy and asthma triggers, such as seasonal pollen, dust, pet dander, and stress
Medications and surgeries
A doctor may recommend one or more of the following medical treatments:
- antihistamines to prevent allergy symptoms
- inhaled and/or intranasal corticosteroids
- leukotriene modifiers that may help symptoms of both hay fever and asthma
- biologic injections for severe asthma that is not well managed
- surgery to remove nasal polyps
- gradual, controlled NSAID desensitization conducted in a clinic
Besides exacerbated asthma symptoms, complications of AIA may include hives (urticaria). The AAAAI estimates that between 20 and 40 percent of people who have chronic hives may have worsening symptoms if they also experience AIA. A type of swelling called angioedema can also occur.
It’s also important to consider long-term side effects of taking aspirin and other NSAIDs, especially when taken for longer than recommended. These include:
- liver or kidney problems
- heart and circulation related conditions, such as heart attack and stroke
Avoid mixing aspirin with the following, too:
- other NSAIDs
- selective serotonin reuptake inhibitors (SSRIs)
- certain medications used to treat autoimmune diseases
Aspirin is a type of NSAID primarily used to relieve pain. But be careful using aspirin if you have a history of asthma, sinusitis, and nasal polyps. These underlying conditions may put you at a higher risk of developing AIA.
Talk with a doctor if you’re concerned about the risks or side effects of taking NSAIDs — or if you have a history of side effects after taking these types of medications. They can help diagnose and treat potential AIA along with related medical conditions.