Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve many types of pain and inflammation. Millions of people use NSAIDs daily for various reasons, making them among the most commonly used drugs in the world. However, NSAIDs are not appropriate for individuals with certain conditions, including asthma and certain allergies. Furthermore, the U.S. Food and Drug Administration recently strengthened its warnings about cardiac risks pertaining to their use.  

NSAIDs can either be prescribed or purchased over-the-counter. They come in several forms, including:

• Oral (pills, tablets, capsules, caplets)
  
  
• Topical (creams, lotions, gels, patches)
  
  
• Liquid
  
  
• Injection:
• • Systemic injection (affects the entire body), or
  • Localized (affects only one area of the body)

NSAIDs prevent inflammation by slowing the body’s production of prostaglandins (chemical messengers). Prostaglandins play a key role in the cause of swelling, pain, stiffness, redness and warmth. NSAIDs, sometimes referred to as anti-prostaglandins, are administered in low doses to prevent pain. Higher doses are commonly used to reduce inflammation. NSAIDs generally begin to affect body systems within four to 24 hours after each dose, although three weeks of continuous use may be required for maximum benefit.

Prostaglandins also protect the lining of the stomach from stomach acid. Because NSAIDs decrease prostaglandin production, the stomach lining is more susceptible to irritation or ulcers when a person takes an NSAID. To minimize this risk, some NSAIDs have a special coating. Prescription or over-the-counter antacids or taking NSAIDs with milk or food may help reduce the risk of ulcers.

NSAIDs may cause some very serious side effects. People with asthma must avoid NSAIDs because the drugs can trigger asthma attacks. This occurs because the drugs also interfere with the body’s production of the enzyme cyclo-oxygenase (COX). Though the mechanism is unclear, it appears that the disruption of COX disturbs parts of the body’s metabolism and increases the generation of leukotrienes, resulting in the constriction of the airways.

A separate, very serious type of reaction to NSAIDs involves the worsening of an existing asthma condition. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), at least 10 percent of asthmatics over the age of 10 will experience a worsening of their condition if they take an NSAID (e.g., aspirin). Because so many people have asthma conditions without realizing it (over 30 percent, according to the AAAAI), anyone who experiences any type of wheezing, coughing or shortness of breath after taking a NSAID should immediately see a physician for a respiratory evaluation.

Some people may fail to recognize their asthma symptoms because they have a condition known as “Samter’s Triad.” This condition involves simultaneously having other types of respiratory symptoms (due to nasal polyps and more common NSAID side effects) that mask the symptoms of asthma. Anyone who experiences nasal or sinus symptoms after taking NSAIDs should have a complete medical evaluation by a physician.

Some individuals have an allergic reaction to NSAIDs. Though this condition is rare, it can be very serious and result in life-threatening anaphylactic shock. 

Allergic reactions to NSAIDs may cause:

• Respiratory symptoms. Includes wheezing, coughing, shortness of breath and runny nose.
  
  
• Skin symptoms. Includes hives and angioedema (swelling).

People who have an allergy to NSAIDs must completely avoid this drug type. People with NSAID allergies can often take up to 1,000 milligrams of acetaminophen safely, but should discuss the safety of all drugs with their physician.

In some people, such as those with coronary artery disease who require long-term use of low-dose aspirin, NSAID use is necessary. Physicians are often able to successfully desensitize people to the allergen, allowing them to safely take it. Desensitization involves limited and controlled exposure to the allergen in a medical setting.

Desensitization is an option for some people with aspirin allergy, nasal polyps and asthma. People with angioedema and hives, however, cannot be desensitized to the drugs. Patients who are interested in desensitization should discuss the option with their allergist.

A specific type of NSAID known as COX-2 inhibitors was used to treat individuals who had stomach sensitivity to traditional NSAIDs. They were thought to treat pain and inflammation as effectively as traditional NSAIDs, but without many of the gastric side effects. However, recent data released by the FDA confirms that certain NSAIDs – notably some COX-2 inhibitors – may increase the risk of cardiovascular events. As a result of these findings, two of the three available COX–2 inhibitors have been withdrawn from the market.

In April 2005, the FDA advised that:

• All NSAIDs except aspirin increase the risk of serious adverse cardiovascular events (e.g., heart attack or stroke).
  
  
• All NSAIDs including aspirin have the risk of serious and potentially life-threatening gastrointestinal bleeding.
  
  
• NSAIDs should not be given to patients immediately after a coronary artery bypass graft.

Because of the adverse way NSAIDs can affect certain individuals, patients are encouraged to speak with their physicians before they begin using this type of drug. In many cases, an alternate drug type (e.g., acetaminophen) can be effectively substituted.