Asthma with beta-blockers and anti-inflammatory painkillers

Beta-blockers work by blocking beta receptors in the heart, which slows the heart rate and lowers blood pressure. The airways also have beta receptors, which, when stimulated, keep the airways open. That is the very mechanism the blue reliever inhaler uses. A beta-blocker can therefore tighten the airways in people who are prone to it, and can also blunt the effect of a reliever.

Aspirin and ibuprofen belong to a family of anti-inflammatory painkillers, NSAIDs. In a minority of people with asthma, they alter how the body processes inflammatory chemicals, which can bring on wheeze, chest tightness and a blocked nose within hours. This is sometimes called NSAID-sensitive asthma, and it is more recognised in adults than in children.

The NHS asthma page says some medicines such as aspirin, ibuprofen and beta-blockers can trigger asthma symptoms in some people, and says to check with a pharmacist or doctor before taking any new medicine. The ibuprofen leaflet lists asthma or allergies, and a previous allergic reaction to aspirin or another NSAID, among reasons ibuprofen may not be suitable, along with stomach ulcers, heart, liver or kidney conditions and clotting problems.

The propranolol leaflet says people with lung disease or asthma should tell their doctor before they take it, and lists those who should not take it, including people with low blood pressure or slow heart rate and certain circulation problems. It also says people with diabetes must tell the doctor because propranolol can affect blood sugar control.

No test reliably predicts who will react. Features that make a problem more likely include adult-onset asthma, nasal polyps, chronic sinus disease, and a past episode of wheeze after aspirin or ibuprofen. Poorly controlled asthma also leaves less reserve, so any additional narrowing matters more.

People with well-controlled asthma may be able to take some of these medicines safely under supervision. That decision, especially for beta-blockers, rests with the prescriber, who may choose a cardio-selective type, use the lowest effective dose, or avoid the class altogether and use another way to control blood pressure or heart rate.

• Tell every prescriber and pharmacist that you have asthma, including for eye drops, which can contain a beta-blocker.

• Do not start an over-the-counter painkiller, cold remedy or migraine product without checking whether it contains aspirin or ibuprofen.

• Mention any previous reaction to aspirin or ibuprofen, even if it was years ago.

• Keep your reliever inhaler with you when trying anything new.

Paracetamol is often the first alternative for pain or fever. For cardiac conditions such as angina, high blood pressure or a fast heart rhythm there are other classes of medicine, and the choice depends on the condition and on the asthma. The NHS notes that paracetamol is preferred to ibuprofen in pregnancy, which is a reminder that the right painkiller varies with the person.

If a beta-blocker or NSAID is judged necessary, many clinicians ask the person to monitor peak flow, symptoms and reliever use closely for the first days, and to seek advice at once if these worsen. Never stop a heart medicine on your own, because stopping suddenly can itself cause problems; speak to the prescriber.

Sit upright, use your reliever as your asthma action plan says, and stop taking the suspected medicine until you have spoken to a pharmacist or doctor, unless it is a heart medicine you have been told never to stop abruptly, in which case phone for advice urgently. The NHS says to call 999 during an attack if you do not improve after using your reliever, feel worse, or do not have an inhaler.

After any attack, the NHS says to see a GP within two days. Mention the new medicine so it can be recorded as a possible trigger and an alternative found.

Controlled asthma is easier to live with alongside other conditions. The NHS describes inhalers as the main treatment, with reliever, preventer and combination types, and tablets or biological therapies if inhalers are not enough. Regular review keeps the plan current, and an asthma action plan tells you what to do when symptoms change.

Existing guides on this site cover adult asthma and exercise-induced asthma. If you also compete in sport, the page on medicines and sport explains how inhalers are treated under anti-doping rules.