NSAID-Exacerbated Respiratory Disease — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyNSAID-Exacerbated Respiratory DiseaseRACP Adult Medicine

A 45-year-old woman presents with chest tightness and wheeze after commencing a new medication. Her peak flow drops by 25% from baseline. She has a history of nasal polyps and asthma. The medication was prescribed for knee pain. Which drug is most likely responsible?

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Correct answer: B — Pregabalin

NSAID-exacerbated respiratory disease (NERD, formerly Samter's triad) consists of asthma, nasal polyps, and sensitivity to COX-1 inhibitors (aspirin, NSAIDs). Ibuprofen inhibits COX-1, causing shunting of arachidonic acid towards the lipoxygenase pathway, generating excess leukotrienes (potent bronchoconstrictors). This occurs in ~20% of asthmatics with nasal polyps. COX-2 selective inhibitors (celecoxib) are generally safe alternatives. Leukotriene receptor antagonists (montelukast) may provide some protection.

Reference: AMH – 2025 – NSAIDs; eTG – 2025 – Respiratory