Asthma Drug Interaction — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsAsthma Drug InteractionORE Part 1

A 55-year-old woman with well-controlled asthma requires dental treatment. She uses a salbutamol inhaler as needed and a beclomethasone inhaler twice daily. Which of the following analgesics should be prescribed with caution?

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Correct answer: B — Ibuprofen

Ibuprofen is a non-selective NSAID and must be prescribed with caution in asthma because NSAIDs can precipitate bronchospasm and acute asthma exacerbations via COX inhibition and leukotriene dysregulation. UK guidance (NHS SPS, NICE, SmPC) identifies NSAIDs as caution-indicated in asthma; 1–5% of UK asthma patients cannot tolerate them. Paracetamol is a safe alternative and is well tolerated in asthma. Codeine phosphate, dihydrocodeine and tramadol are opioid analgesics without specific asthma-related pharmacological cautions at therapeutic analgesic doses (respiratory depression from opioids is not the primary concern in asthma management). For dental pain in this patient, paracetamol or codeine would be appropriate first-line alternatives.

Reference: NHS Specialist Pharmacy Service. Using NSAIDs in asthma. https://sps.nhs.uk/articles/using-nsaids-in-asthma/ (Updated January 2025); Medicines.org.uk SmPC for ibuprofen (Brufen); NICE CG183 Drug allergy guidance.