NSAID Sensitivity and Asthma: What Patients Should Watch

If you have asthma and reach for ibuprofen or aspirin for a headache, you could be walking into a silent danger zone. For about 7% of people with asthma, these common painkillers don’t just fail to help-they can trigger a life-threatening asthma attack. This isn’t an allergy in the usual sense. It’s a condition called NSAID-Exacerbated Respiratory Disease, or NERD. And if you’re not aware of it, you might keep making the same dangerous mistake over and over.

What NERD Really Feels Like

Imagine this: you take a pill for a migraine, and within 30 minutes, your nose starts running like a faucet. Your chest tightens. Your breathing turns shallow and wheezy. You can’t catch your breath. You’re not sick with a cold. You didn’t eat something strange. You just took a painkiller-and your body reacted like it was under attack.

This is NERD in action. It’s not rare. In fact, among people with asthma who also have chronic nasal polyps or long-term sinus trouble, up to half may have it. Symptoms usually show up within 30 minutes to three hours after taking an NSAID. The reaction isn’t mild. It’s often severe enough to land people in the ER with bronchospasm, swelling in the airways, and full-blown asthma exacerbation.

Many patients don’t realize what’s happening at first. They think it’s a cold, an allergy to pollen, or even stress. One woman in Edinburgh told her doctor she’d been having "seasonal asthma flare-ups" every winter-until she remembered she always took ibuprofen for her sore neck after shoveling snow. Once she stopped, her symptoms vanished.

Who’s at Risk?

NERD doesn’t hit everyone the same. It’s not random. The people most likely to develop it share a few key traits:

• They have asthma and chronic rhinosinusitis with nasal polyps
• They’re female
• They’re between 30 and 50 years old
• They’ve had asthma for years, often with poor control
• They’re overweight or have a history of smoking

Most people are diagnosed in their 30s or 40s. It’s rare under age 20. And while men can get it too, about 70% of diagnosed cases are in women. The link with nasal polyps is especially strong. If you’ve had recurring polyps removed multiple times and still struggle with breathing, NERD should be on your doctor’s radar.

Why Do NSAIDs Trigger This?

It’s not about being allergic to the pill. It’s about what happens inside your body after you swallow it.

NSAIDs like aspirin, ibuprofen, and diclofenac block an enzyme called COX-1. That’s how they reduce pain and inflammation. But in people with NERD, blocking COX-1 throws off a delicate chemical balance. Instead of making protective anti-inflammatory molecules like prostaglandin E2, your body starts pumping out huge amounts of leukotrienes-powerful chemicals that cause airway tightening, mucus buildup, and swelling.

Studies show that people with NERD already have lower levels of protective prostaglandins in their nasal and lung tissue. When NSAIDs hit, it’s like pulling the plug on your body’s natural safety net. The result? Your airways go into overdrive.

This is why acetaminophen (paracetamol) is usually safe-it doesn’t block COX-1 the same way. And drugs like celecoxib, which only target COX-2, are often tolerated too.

What Medications Are Safe?

Not all painkillers are created equal. Here’s what you need to know:

• AVOID: Aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, indomethacin-any traditional NSAID.
• Usually SAFE: Acetaminophen (paracetamol) at doses under 1000mg per dose. Most NERD patients tolerate this well.
• Often SAFE: Celecoxib (Celebrex) and other COX-2 inhibitors. These are less likely to trigger reactions, but not risk-free.
• NEVER ASSUME: Cold and flu remedies, menstrual pain relievers, and topical gels often contain NSAIDs. Check the label.

Many people don’t realize that some migraine pills, arthritis creams, and even children’s fever reducers contain ibuprofen or aspirin. A patient in Glasgow ended up in hospital after using a "natural" muscle rub that listed menthol and methyl salicylate-a form of aspirin. She didn’t know it counted.

What About Aspirin Desensitization?

There’s one exception to the "never take NSAIDs" rule: aspirin desensitization.

This is a controlled medical procedure done in a hospital setting. Over several hours, you’re given tiny, increasing doses of aspirin under close supervision. If you tolerate it, your body can be trained to handle it without triggering a reaction.

For some people, this is life-changing. Studies show it can reduce nasal polyp regrowth, improve asthma control, and even cut down on steroid use. But it’s not for everyone. It’s only offered at specialist centers, and you need to be stable on your asthma meds first. It’s also not a cure-you still need to keep taking daily aspirin to maintain the effect.

How to Protect Yourself

Knowledge is your best defense. Here’s what to do:

1. Get tested if you have asthma + nasal polyps or chronic sinusitis. Ask your doctor about NERD.
2. Keep a list of all your medications-prescription, OTC, and topical. Show it to every new doctor.
3. Learn to read labels. Look for: ibuprofen, aspirin, naproxen, diclofenac, ketoprofen, salicylate, methyl salicylate.
4. Carry a medical alert card or app listing your NSAID sensitivity.
5. If you’ve had a reaction before, avoid all NSAIDs-even if it was years ago. The sensitivity doesn’t go away.

One woman in Edinburgh started carrying a small card in her wallet that says: "NSAID SENSITIVE. NO IBUPROFEN, ASPIRIN, OR NAPROXEN. ACETAMINOPHEN OK." She says it’s saved her from three emergency visits.

What to Do If You Have a Reaction

If you take an NSAID and feel your chest tightening, nose running, or throat closing:

• Stop taking the medication immediately.
• Use your rescue inhaler if you have one.
• Call emergency services if breathing doesn’t improve within minutes.
• Don’t wait to see if it "gets better." This isn’t a mild reaction.

Even if you’ve had a mild reaction before, the next one could be worse. NERD reactions are unpredictable.

Bottom Line

NSAID sensitivity isn’t something you can ignore. It’s not just about avoiding a few pills-it’s about understanding how your body reacts to common medicines. If you have asthma, especially with nasal polyps or chronic sinus trouble, you’re at higher risk. Don’t assume painkillers are harmless. Talk to your doctor. Get tested. Learn what’s safe. And never take a new medication without checking the ingredients.

There’s no shame in being cautious. In fact, it’s the smartest thing you can do.